Credit Application - D'Ambrisi Foods

Trade Name

Business Name

Address

Address Line 1

City

State

Zip Code

Email

Phone

Fax

IF DIFFERENT THAN ABOVE

If Different Than Above

Business Type

Partnership
Corporation
Proprietorship

Federal Tax ID Number

Business Established or Acquired Date

Building Information

Owned
Rented
Concession

Terms Requested

COD
Net 30
Net 60

PLEASE PROVIDE FULL INFORMATION ON ALL PARTNERS,CORPORATE OFFICERS OR PROPRIETORS

Name

First

Last

Title or Company Position

Complete Home Address

Home or Personal Mobile Number

Social Security Number

Bank Name

Phone

Address

Account Number

Account Name

Reference 1

Name

Phone

Address

Reference 2

Name

Phone

Address

Reference 3

Name

Phone

Address

The undersigned(purchaser) agrees that all purchases made by the purchaser from D’Ambrisi Wholesale Foods, LLC (seller) are subject to the following terms and conditions:

All amounts due seller are payable in accordance with payment terms granted by sellers credit dept. if any amount due seller is not paid in accordance with such payment terms, a delinquency charge shall be added to the sum due which charge will equal 1.5% of the delinquent balance per month.
Purchaser shall pay seller a service charge of $35.00 for all check returned by the purchasers bank.
If seller deems it advisable to place account for collection with an attorney.

I INDIVIDUALLY PERSONALLY GUARANTEE ALL PAYMENTS AND DEBTS OWED BY THE COMPANY NAME STATED ABOVE TO D'AMBRISI WHOLESALE FOODS,LLC AND CERTIFY THAT ALL OWNER INFORMATION ON THIS FORM IS CORRECT

Signature

Clear Signature