Credit Application

Date*
Date Format: MM slash DD slash YYYY
Company Name*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
Fax
Type of Ownership*
Year Established*
Federal Tax ID#*
ACCOUNTS PAYABLE CONTACT INFORMATION
Name*
First Last
Title*
Phone*
Fax
E-mail address for invoices and statements:*
Enter Email Confirm Email
BANK INFORMATION
Name of Bank*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone
Phone
Account #*
Bank Routing #*
TRADE REFERENCE INFORMATION
We require a minimum of three trade references. List only the companies with whom you currently have terms, not accounts paid by credit card or COD. To facilitate this process, be sure to fill out all the fields for the references you list. If you would like to provide more then three, just copy this form and attach it to the original application. The following companies do not disclose credit information: Burt’s Bees, Frontier Natural Products Co-op, NOW Foods, and United Natural Foods, Inc.
#1 Company Name*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
Fax
Email
Account #*
#2 Company Name*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
Fax
Email
Account #*
#3 Company Name*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
Fax
Email
Account #*
We would like to establish credit with your company. We authorize you to contact our references we have listed.
Name*
First Last
Title*
Signature*
Date*
Date Format: MM slash DD slash YYYY

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Credit Application

ACCOUNTS PAYABLE CONTACT INFORMATION

BANK INFORMATION

TRADE REFERENCE INFORMATION

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