Credit Application – OLD Credit Application Credit Application Your Business Name Sellers Permit # Upload Image of Sellers Permit Choose File Engaged In Business of Selling Business Type Individual Partnership CorporationFederal Tax Id Save & Resume PreviousNext Authorized Signature Contact First Name Last Name Email Phone Buyer Contact Information First Name Last Name Email Phone Accounting Contact Information First Name Last Name Email Phone Save & Resume PreviousNext Shipping & Billing Address Shipping AddressAddress Line 1 Address Line 2 City State Zip Code Billing AddressAddress Line 1 Address Line 2 City State Zip Code Save & Resume PreviousNext Bank Information Bank Name Account Number AddressAddress Line 1 Address Line 2 City State Zip Code Bank Contact First Name Last Name Email Phone Save & Resume PreviousNext First Trade Reference Application will not be processed without complete information. Business Name Account Name or Number AddressAddress Line 1 Address Line 2 City State Zip Code Contact Information First Name Last Name Email Phone Save & Resume PreviousNext Second Trade Reference Application will not be processed without complete information. Business Name Account Name or Number AddressAddress Line 1 Address Line 2 City State Zip Code Contact Information First Name Last Name Email Phone Save & Resume PreviousNext Acknowledgement & Signature Terms & Conditions The first order will be COD. Upon approval of credit and credit limit sales are due net 7 days from the date of invoice unless otherwise specified by Flying Goat Coffee’s Credit Department. All past due accounts accrue interest at the rate of 18% per annum, 1.5% per month, on the unpaid balance of each invoice, beginning the next day after the due date and continuing to accrue on that unpaid balance until paid in full. All returned checks shall be assessed a $25.00 return check fee. Sellers Resale Information I HEREBY CERTIFY that I hold valid seller’s permit No. ISSUED PURSUANT TO THE Sales and Use Tax Law: that I am engaged in the business of selling , that the tangible property described herein which I shall purchase from Flying Goat Coffee will be resold by me in the form of tangible personal property; PROVIDED, however, that in the event that any such property is used for any purpose other than retention, demonstration, or display while holding it for sale in the regular course of business, it is understood that I am required by the Sales and Use Tax law to report and pay the tax, measured by the purchase price of such property. Description of property to be purchased I , have read and agree to the above Terms & Conditions, Sellers Resale Information, Terms of Service, and Privacy Policy. Save & Resume PreviousNextAuthorizing Signature Sign Here I acknowledge that my signature below indicates that the information provided is true and correct and I authorize Flying Goat Coffee to validate the information provided, including but not limited to contacting banks and trade references for verification purposes. I authorize my bank and listed references to release credit information for the purpose of establishing an open account with Flying Goat Coffee. I understand that this authorization is necessary to process my application accurately and efficiently. I also acknowledge that Flying Goat Coffee will handle my personal information in accordance with applicable privacy laws and regulations. By signing below, I confirm my consent and agreement to these terms. Date Authorizing Signature Name: Company Title Save & Resume Previous Submit Application
