Credit Application

    Business Name*

    Business Type*

    Business Structure*

    Federal Tax ID*

    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*

    Shipping Address


    Address Line 1*

    Address Line 2

    City*

    State*

    Zip*

    Billing Address


    Address Line 1*

    Address Line 2

    City*

    State*

    Zip*

    Bank Information


    Bank Name*

    Account Number*

    Bank Address Line 1*

    Address Line 2

    City*

    State*

    Zip*

    Bank Contact Information


    First Name*

    Last Name*

    Email*

    Phone*

    First Trade Reference


    Business Name*

    Account Name or Number*

    Address Line 1*

    Address Line 2

    City*

    State*

    Zip*

    First Trade Contact Information


    First Name*

    Last Name*

    Email*

    Phone*

    Second Trade Reference


    Business Name*

    Account Name or Number*

    Address Line 1*

    Address Line 2

    City*

    State*

    Zip*

    Second Trade Contact Information


    First Name*

    Last Name*

    Email*

    Phone*

    Acknowledgement & Signature


    Terms & Conditions

    Upon approval of credit and credit limit, sales invoices are due upon receipt of product 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 number (entered below) ISSUED PURSUANT TO THE Sales and Use Tax Law: that I am engaged in the business of selling coffee and/or coffee products, 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.

    Sellers Permit Number*

    Date*

    Upload Image of Sellers Permit*