Truly Good Foods Credit Application

CREDIT APPLICATION AND AGREEMENT

A. The following information is submitted to TRULY GOOD FOODS for consideration as the basis for extending credit. FAILURE TO SUBMIT COMPLETE INFORMATION WILL CAUSE THIS APPLICATION TO BE RETURNED TO APPLICANT.

Number of Years in Business*

Credit Requested*

Tax ID #*

Company's Legal Name*

Billing Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Shipping Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Telephone*

Fax

Type of Organization*

Corporation Individual Proprietorship Partnership

Contract or Purchasing Group Affiliation*

Type of Business*

Email*

Pay with Credit Card

Yes No

Group Registration Number

State Tax Exemption Signed Form

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Credit Card Authorization Form

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Company Officers, Owners and/or Partners

1. Name

First Name

Last Name

1. Title

1. Telephone

1. Home Address

Address Line 1

Address Line 2

City

State

ZIP Code

2. Name

First Name

Last Name

2. Title

2. Telephone

2. Home Address

Address Line 1

Address Line 2

City

State

ZIP Code

3. Name

First Name

Last Name

3. Title

3. Telephone

3. Home Address

Address Line 1

Address Line 2

City

State

ZIP Code

Trade or Vendor References (Three are required. No C.O.D.)

1. Company Name

1. Account #

1. Complete Address

Address Line 1

Address Line 2

City

State

ZIP Code

1. Telephone

1. Fax

2. Company Name

2. Account #

2. Complete Address

Address Line 1

Address Line 2

City

State

ZIP Code

2. Telephone

2. Fax

3. Company Name

3. Account #

3. Complete Address

Address Line 1

Address Line 2

City

State

ZIP Code

3. Telephone

3. Fax

B. The undersigned certifies that the contents of this Application, and all information submitted herein and referred to, is true and accurate, and accurately represents and reflects the financial condition, without material change, of the Applicant to this date. It is agreed by the undersigned that:(1) all goods, merchandise, services and other items purchased by Truly Good Foods by the applicant will be paid for in full within fifteen (15) days of date of our sale invoice; (2) the Applicant and undersigned hereby agrees to pay all costs, expenses, and attorney fees as Truly Good Foods may incur in any manner in collecting any sums past due (not within thirty (30) days of date of sale invoice) as Open Account credit extended by Truly Good Foods to the Applicant; (3) the Applicant agrees to C.O.D. terms, credit card or prepayment until credit is approved.

C. This is to certify that I am a principal at company and I personally guarantee the account:

Name*

First Name

Last Name

Manager's Email Address

File

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Signature*

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