Application Initiated by
Email Address
Date
Company Trades As
Corporate Structure Partnership Corporation (jump to) Individual (jump to)
Please fill in the names and addresses of all principal Partners
Partner One's Name
Address
Home Phone Number
Partner Two's Name
Partner Three's Name
Please fill in the name and address of the President and General Manager
President
General Manager
If individually owned but not incorporated, please fill in the name of the individual owner
Name
The undersigned, as an authorized agent for buyer, agrees the buyer shall pay all obligations together with attorney and/or collections fees incurred. If the buyer fails to comply with any of the terms and/or conditions and/or fails to satisfy any obligation of the buyer to the seller; or if the seller with reasonable cause deems the obligation uncollectible without professional and/or legal assistance.
Enter your name as Signature
Title
Please complete this form and submit your most recent financial statement (to Wholesome Foods, Inc., 986 South Ox Rd., Edinburg, VA 22824), which we shall hold in strict confidence.
Phone Number
Billing Address
Delivery Address
Person(s) to deal with
Line of Business
How long in business
Expected volume, frequency of deliveries, and other comments on probable requirements
Credit Line Requested
Our standard credit terms are Net 7 Days from Invoice Date
Phone
I hearby authorize Wholesome Foods to obtain all pertinet information regarding my credit records necessary in order to process this application. Failure to pay any debt to Wholesome Foods Inc. will result in a charge of 2% per month as well as court costs if needed and attorney fees.
