Specialist Nutrition US - Specialist Nutrition US

Customer / Business Details

Customer / Business Name:

Business Class

Corporation LLC Partnership Individual

Phone:

Federal ID / SS#:

Email:

Website:

Mailing Address

Address:

City:

State:

ZIP:

Shipping Address

Address:

City:

State:

ZIP:

Credit / Business Type

Line of Credit Requested (per month):

Type of Business:

Dairy Beef Other

Milk Company:

Farm Nutritionist

Number of Cows/Heifers Fed:

Number of Cows/Heifers on Farm

If you answered other above (please specify):

Firm / Contacts

Accounts Payable Contact

Name:

Phone:

Email:

Purchasing Contact

Name:

Phone:

Email:

Partner #1 / President

Name:

SS#:

Phone:

Email:

Address:

City:

State:

ZIP:

Partner #2 / Vice-President

Name:

SS#:

Phone:

Email:

Address:

City:

State:

ZIP:

Bankruptcy

Has the firm or any of its pincipals ever filed for bankruptcy?

Yes No

If you answered yes to the bankruptcy question above, please explain:

References

Banking Reference

Name:

Phone:

Account No:

Email:

Length of relationship (years):

Type of account:

Address:

City:

State:

ZIP:

Trade Reference #1

Business Name:

Referee Name:

Account No:

Phone:

Email:

Address:

City:

State:

ZIP:

Trade Reference #2

Business Name:

Referee Name:

Phone:

Email:

Address:

City:

State:

ZIP:

Attachments

Use this field to upload any relevant documents, giving files helpful names/descriptions.

Terms and Conditions

Should credit availability be granted by Specialist Nutrition, all decisions with respect to the extension or continuation is at the sole discretion of Specialist Nutrition. Applicant agrees to provide Specialist Nutrition, upon request, updated financial information or a revised credit application, as conditions for the continued extension of credit. Credit not extended to delinquent acounts. To the extent not prohibited by law, applicant shall pay all reasonable costs and expenses of collections, including attorney fees. Specialist Nutrition may terminate any credit availability within its sole discretion. I (we) the undersigned certify that the foregoing statements and representations are true and correct statements. The undersigned representative of the applicant is duly empowered to enter into and make binding agreements on behalf of the applicant. I (we) further represent that the customer applying for credit has the financial ability and willingness to pay for all invoices within established terms. Furthermore, the undersigned does hereby grant permission to Specialist Nutrition or their designated agent to check any credit information listed and obtain any additional information about the credit experience in order to evaluate the credit request made hereby. This credit application and any and all orders are subject to and governed by Specialist Nutrition's Terms & Conditions as prevailing at the time of sale. The current Terms & Conditions are listed below. Customer acknowledges that these Terms & Conditions may change over time and the placing of any order by the customer is explicit acceptance of the prevailing Terms & Conditions.

Acceptance of Terms and Conditions

I accept the terms and conditions.

Credit Application

Customer / Business Details

Mailing Address

Shipping Address

Credit / Business Type

Firm / Contacts

Accounts Payable Contact

Purchasing Contact

Partner #1 / President

Partner #2 / Vice-President

Bankruptcy

References

Banking Reference

Trade Reference #1

Trade Reference #2

Attachments

Terms and Conditions

Acceptance of Terms and Conditions

Terms & Conditions