Credit Application – wholesale.flyinggoatcoffee.com

Credit Application

Your Business Name

Sellers Permit #

Upload Image of Sellers Permit

Choose File

Engaged In Business of Selling

Business Type

Individual

Partnership

Corporation

Federal Tax Id

Authorized Signature Contact

First Name

Last Name

Email 1

Phone

Buyer Contact Information

First Name

Last Name

Phone

Accounting Contact Information

First Name

Last Name

Phone

Shipping & Billing Address

Shipping Address

Address Line 1

Address Line 2

City

State

Zip Code

Billing Address

Address Line 1

Address Line 2

City

State

Zip Code

Bank Information

Bank Name

Account Number

Address

Address Line 1

Address Line 2

City

State

Zip Code

Bank Contact

First Name

Last Name

Phone

First Trade Reference

Application will not be processed without complete information.

Business Name

Account Name or Number

Address

Address Line 1

Address Line 2

City

State

Zip Code

Contact Information

First Name

Last Name

Phone

Second Trade Reference

Application will not be processed without complete information.

Business Name

Account Name or Number

Address

Address Line 1

Address Line 2

City

State

Zip Code

Contact Information

First Name

Last Name

Phone

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.

Authorizing 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