Credit Application and Agreement

The following information is submitted to Snacks on Racks, Incorporated (hereinafter known as “Snacks on Racks”) for consideration as the basis for extending credit. Snacks on Racks product cannot be sold to any entity without this form being received and validated by Snacks on Racks. All fields are required unless otherwise noted.

Company's Legal Name
Address
Address 2 (optional)
City, State  Zip   
Telephone Number
Type Of Organization Individual Proprietor
C Corporation
S Corporation
Partnership
LLC
If Corporation, State of Incorporation
Tax ID Number
Years in Business @ this location
Bank Name
Complete Bank Address
Bank Account Number
Bank Contact Name
Bank Phone Number
Trade Ref 1 Name
Complete Trade Ref 1 Address
Trade Ref 1 Account Number
Trade Ref 1 Contact Name
Trade Ref 1 Phone Number
Trade Ref 2 Name
Complete Trade Ref 2 Address
Trade Ref 2 Account Number
Trade Ref 2 Contact Name
Trade Ref 2 Phone Number
Trade Ref 3 Name
Complete Trade Ref 3 Address
Trade Ref 3 Account Number
Trade Ref 3 Contact Name
Trade Ref 3 Phone Number
Contact First Name
Contact Last Name
Contact Phone
Contact Fax (optional)
AP Contact First Name
AP Contact Last Name
AP Contact Phone
AP Contact Fax (optional)

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 all invoices are Net 30 from the date of delivery. Should Snacks on Racks incur costs, including collection and attorney fees, due to past due sums, the Applicant and undersigned agrees to pay all costs.

Agreement Signed By
Title
Agreed and Submitted On