East Side Entrees :: Credit Application

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www.eastsideentrees.com
www.breakfastbreaks.com
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Credit Application

If you are interested in submitting a credit application, please fill out this form electronically or click here to download a version you can print, fill out, and fax back to us.

Organization Information

Organization Name	*
Club Code Number	*
Address	*
Address (line 2)
City	*
State	*
Zip/Postal Code	*
Phone	*
Fax
Email Address	*
Federal Tax ID	*
Accounts Payable Contact	*
Authorized Agent	*

Customer Shipping Information (Primary Ship-To)

Check here if this information is the same as above
Name of Shipping Location	*
Delivery Address	*
Address (line 2)
City	*
County	*
State	*
Zip	*
Delivery Contact	*
Delivery Phone	*
Delivery Fax
Receiving Hours	*

Credit and Business References

Name	*
Address	*
City	*
Phone	*
Fax	*

Name	*
Address	*
City	*
Phone	*
Fax	*

Name	*
Address	*
City	*
Phone	*
Fax	*

Bank Reference

Name of Bank	*
Bank Address	*
City	*
State	*
Zip	*
Account Number	*
Bank Officer to Contact	*
Title	*
Phone	*

Credit Agreement:

The undersigned does hereby make application to East Side Entrees for a credit accoutn and by doing so authorizes East Side entrees in connection with the establishment and maintenance of this account to investigate our credit worthiness and financial responsibility. The undersinged warrants the above information is true and accurate in every respect. I affirm our firm is financially able to meet any commitments we have made and we will pay East Side Entrees invoices according to East Side Entrees net 10 Day Terms.

Credit Terms will be extended when ordering a minimum of 7 pallets. All orders less than the 7 pallets will be payment in advance, (Check/Credit Card/Debit Card, Bank Check, Money Order) before orders will be shipped. Once credit is approved, terms are net 10 days.

Federal Tax Identification Number	*
Signature	*
Name	*
Title	*
(Must be a Corporate Officer)