Credit Application

Date*

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

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*

Business

ACCOUNTS PAYABLE CONTACT INFORMATION

BANK INFORMATION

TRADE REFERENCE INFORMATION