Credit Application

*required

Your Name*

Your Email*

Company Name*

Company Type*

Phone Number*

Fax Number*

Street Address*

City*

State*

Zip Code*

Annual Sales*

DUNS Number*

Billing Address if Different from Above

Street Address*

City*

State*

Zip Code*

Company Directors/Officers/Principal

Name*

Title*

Home Address*

Phone*

Name*

Title*

Home Address*

Phone*

Name*

Title*

Home Address*

Phone*

Accounts Payable Information

Name*

Phone*

Email*

Name*

Phone*

Email*

Trade References

Vendor*

Contact*

Phone*

Payment Address*

City*

State*

Zip Code*

Vendor*

Contact*

Phone*

Payment Address*

City*

State*

Zip Code*

The undersigned warrants that the information contained in this credit application is true and accurate and agrees that the applicant company will pay for all goods and services as they come due. Any account balance unpaid beyond 15 days is considered past due. Once an account is considered delinquent, the account may be charged an additional 20% of the past due account balance. If the account continues to remain delinquent, it will be subject to outside collections actions, or turn over to an attorney for possible legal actions. In addition, the prevailing party in Court actions shall be entitled to compensation for reasonable attorney's fees as well as any other costs associated with filing of said legal actions. Delinquent accounts may result in Bread Man Baking Co. being unable to provide additional products or services until account is brought current.

Type your full name to acknowledge your consent.*

Date*