Online Credit Application Fancy Foods, Inc. - Credit Application Please fill in all mandatory fields. "*" indicates required fields Step 1 of 5 20% Date MM slash DD slash YYYY Referred By:* BILL TO:* Corp Name Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code TEL NO.*FAX NO.EMAIL ADDRESS* Delivery Window*Please indicate your available delivery times: Chose one:* PROPRIETORSHIP CORPORATION PARTNERSHIP FED ID#* Date business started* MM slash DD slash YYYY SHIP TO: (If different than Bill To Address) Trade Name Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code TEL NO.FAX NO. CONTACT INFORMATIONType of Business*WHOLESALERETAILRESTAURANTAccounts Payable Contact* Buyer Contact* OWNERTitle*OwnerPresidentVice PresidentAre you the only owner?* Yes No Name* First Last Home Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Social Security No.*Date of Birth* MM slash DD slash YYYY Cell Phone*Home PhoneADDITIONAL OWNERName First Last TitleOwnerPresidentVice PresidentHome Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Social Security No.Date of Birth MM slash DD slash YYYY Cell PhoneHome Phone TRADE REFERENCES: (INCLUDING ALL MEAT SUPPLIERS)If you do not have any meat references please provide produce referencesReference #1Company Name* Contact Name* First Last Phone*Yrs. Bought*Less than 11 Year2 Year3 Year4 Year5 Year6 Year7 Year8 Year9 Year10 or MoreRecent High Credit* Weekly Sales* Current O/S Balance* Terms of Sale* Reference #2Company Name Name First Last PhoneYrs. BoughtLess than 11 Year2 Year3 Year4 Year5 Year6 Year7 Year8 Year9 Year10 or MoreRecent High Credit Weekly Sales Current O/S Balance Terms of Sale Reference #3Company Name Name First Last PhoneYrs. BoughtLess than 11 Year2 Year3 Year4 Year5 Year6 Year7 Year8 Year9 Year10 or MoreRecent High Credit Weekly Sales Current O/S Balance Terms of Sale CHANGES IN OWNERSHIP* Applicant agrees to notify Fancy Foods Inc. by certified mail of any CHANGES in ownership. Terms and Conditions* Yes, I have read and understood the terms and conditions: By submitting this form, Applicant agrees to notify Fancy Foods Inc. in writing of any CHANGES in ownership, else liability will continue to accrue for transactions made under the Applicant's account. Customer hereby expressly agrees that all Customer orders are subject to the Terms & Conditions of Sale of Fancy Foods, Inc. which are available at www.fancyfoodsinc.com, and are hereby incorporated in full by reference. Fancy Foods, Inc. limits acceptance of all orders to its Terms & Conditions of Sale, and all offers made by Customer, whether written or verbal, not expressly accepted by Fancy Foods, Inc. are objected to and rejected. Customer further agrees that Fancy Foods, Inc. shall be entitled to the payment by the Customer of accrued interest on any unpaid balance from its due date until payment is made at the rate of one and one half percent (1.5%) per month. In the event Fancy Foods, Inc. takes any legal action to collect any amount due, Customer shall reimburse Fancy Foods, Inc. for its reasonable costs and expenses incurred, including without limitation court costs and the reasonable fees and disbursements of counsel.SIGNATURE* Personal Guarantee Personal Guarantee For value received and in order to induce FANCY FOODS INC., to extend credit to the above named account, I the undersigned, hereby personally guarantee prompt payment when due of any and all debts to FANCY FOODS INC., arising out of sales or advances by FANCY FOODS INC., to the above named account, including late interest, Attorney's fees and disbursements. This is a continuing guarantee. Notice of Acceptance of this guarantee is waived. Use of Corporate titles shall in no way limit the liability of the signatory. This is an absolute, continuing and unconditional guarantee of payment. Name First Last SIGNATURE Social Security No.Date MM slash DD slash YYYY Bank TradePlease provide FANCY FOODS INC., And / or Sea Fax, Inc. with information regarding my credit history with your firm. I, hereby, authorize the release of this information for credit determination purposes. CORPORATE NAME OF APPLICANT AND TRADE NAME (S): Corporate Name* Trade Name* Authorized Person First Last SIGNATURE* Title* Date* MM slash DD slash YYYY Bank InformationDate Opened* MM slash DD slash YYYY Bank Name* Account No.* Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Ext. Person To Contact* First Last * Yes, I have read and understood the terms and conditions