2910 Camino Diablo, Suite 100
Walnut Creek, CA 94597
Phone: (925) 746-7520 / Fax: (925) 746-8966
CONFIDENTIAL CREDIT APPLICATION
Business Information:
Company Name:______Years in Business: ______
P.A.C.A. License #:______(or) Agriculture Canada License #: ______
Dunn and Bradstreet # ______Blue Book # ______
Address: ______
City/ State/ Zip: ______
Phone: ______Fax: ______
Principal Sales Contact Name: ______
E-Mail Address: ______
Accounting Contact Name: ______
E-Mail Address: ______
Business website address: ______
Entity (check one): Corporation _____ Partnership ______Individual ______
Principals and Proprietors/ Titles:
______
______
______
Federal Tax I.D. #: ______
Billing Information, if different than business address above, please provide:
Address: ______City/ State/ Zip: ______
Invoicing Preference: Mail ______Fax ______E-mail ______
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Bank Reference and Credit Information:
Annual Gross Sales: ______Credit Amount Requested: ______
Bank Name/ Branch: ______Account #: ______
Bank Name/ Branch: ______Account #: ______
Trade References:
(1) Company Name: ______Phone: ______
Contact Name: ______
(2) Company Name: ______Phone: ______
Contact Name: ______
(3) Company Name: ______Phone: ______
Contact Name: ______
The undersigned of this application is for the extension of credit by Greenfield Fresh, Inc., and hereby authorizes the bank named above to release the banking information for our company. The applicant understands the information furnished in this application will form a basis for credit extension and accordingly, warrants that the information is true, correct and current. If credit is extended, the applicants agree to abide by the terms and condition as stated on the invoice and to reimburse the company for reasonable attorney’s fees, court costs incurred by the company resulting from breach of the terms and conditions of sales and credit extended with product sold to the applicants. All information received will be strictly confidential.
In accordance with the Perishable Agricultural Commodities Act (P.A.C.A.) of 1930 (7 U.S.C. 499e ©), the seller of these commodities retains a trust claim over these commodities, all inventories of food or other products derived from these commodities until full payment is received. If collection efforts are made by Greenfield Fresh, Inc., to collect unpaid past due balances, Greenfield Fresh, Inc., will be entitled to attorney(s) fees and costs associated therewith.
No claims will be accepted unless supported by a USDA Inspection within 24 hours of arrival. Any variance noted by receiver as to quantity, quality, price, unloading fees, market declines or product condition must be brought to our attention within 24 hours of arrival. No adjustments to this invoice will be accepted without written authorization from this office. Past due accounts may be subject to a 1.5% per month (18% per annum) finance charge computed daily and compounded annually.
Applicant Signature: ______Date: ______
Name / Title (print): ______
Greenfield Fresh, Inc. 2910 Camino Diablo, Ste. 100 Walnut Creek, CA 94597
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