High Roller Sushi Application for a Business Account

Primary Contact *
Primary Contact
Company Information *
Phone *
Registered Company Address *
Registered Company Address
Ship To
Ship To
Please leave blank if address is the same as Registered Company Address.
Business and Credit Information
Primary Business Address *
Primary Business Address
Phone *
Type of Account *
Additional Requirements
Address same as above
Credit Card Billing Address
Credit Card Billing Address
Maintain Credit Card on File *
Please reference the bottom of this page for our terms and conditions *
Please initial in the form below
Date *

By submitting this form, you are agreeing to our terms and conditions:

1. All invoices are due upon receipt of invoice.
2. Claims arising from invoices must be made within seven working days.
3. By submitting this application, you authorize HIGH ROLLER SUSHI, LLC to make inquiries into the banking reference that you have supplied.