OFFICE USE ONLY
Customer # ________________
Price List _________________
Salesperson ________________
Terms ____________________
2101 Jerrold Avenue, Suite 100
Sa n Fra n ci sco , C A 9 4 1 2
(415) 824-7419 Fax (415) 824-7819
Ship Via __________________
Territory __________________
CREDIT APPLICATION, CREDIT AGREEMENT
AND PERSONAL GUARANTEE
BUSINESS CONTACT INFORMATION
Legal Name of
Business
DBA
(Doing Business As)
Date Commenced
Type of Business
Tax ID Number
□sole proprietorship □partnership □corporation □LLC
Applicant Name
Title
Business Address
(City, State ZIP Code)
Phone
Cell Phone
E-mail
Fax
ADDITIONAL APPLICANT/CONTACT
Applicant Name
Title
Phone
Cell Phone
E-mail
Fax
BILLING INFORMATION
Billing Contact
Title
Billing Address
(City, State ZIP
Code)
Phone
Email
Fax
Other
BANK REFERENCES
Bank Name
Account Number
Bank Address (City, State, ZIP)
Phone
Fax
Page 1 of 3
2101 Jerrold Avenue, Suite 100
Sa n Fra n ci sco , C A 9 4 1 2 4
(415) 824-7419 Fax (415) 824-7819
BUSINESS/TRADE REFERENCES
*FOOD RELATED VENDORS ONLY
Company Name
Type of Account
Business Address
(City, State ZIP Code)
Phone
Fax
Company Name
Type of Account
Business Address
(City, State ZIP Code)
Phone
Fax
Company Name
Type of Account
Business Address
(City, State ZIP Code)
Phone
Fax
1.
2.
I/We do hereby agree to the seller’s terms and conditions of sale as documented by the seller and agree to make all payments within
the specified time limit listed on each said invoice. A late charge of 1.5% per month (18% per annum) may be charged on all invoices
past due. If a lawsuit is instigated to collect any overdue portion of my account, I/we promise to pay additional sums as the court may
adjudge reasonable for attorney fees allowed in said suit; and agree that jurisdiction for the purposes of a collection action shall be
the County of San Francisco.
For the purpose of establishing credit with Earl’s Organic Produce, Inc., I/We certify that all the financial information provided is
true and correct. I/We authorize Earl’s Organic Produce, Inc. to contact and investigate our bank references and business/trade
references. I/We authorize Earl’s Organic Produce, Inc. to obtain a credit report for the purpose of evaluating our credit worthiness
in connection with this application for credit.
SIGNATURES
Signature
Signature
Name and Title
Name and Title
Date
Date
Page 2 of 3
2101 Jerrold Avenue, Suite 100
Sa n Fra n ci sco , C A 9 4 1 2 4
(415) 824-7419 Fax (415) 824-7819
AUTHORIZATION TO OBTAIN CREDIT REPORT
I hereby give consent for Earl’s Organic Produce, Inc. to obtain a consumer credit report on me/us for the purpose of evaluating my/our credit
worthiness in connection with this application for credit.
SIGNATURES
Signature
Signature
Name
Name
Date
Date
PERSONAL GUARANTEE
I/We personally guarantee all purchases made from Earl’s Organic Produce, Inc. by the above-described business. I/We understand that this
Personal Guarantee Agreement is continuing and absolute. I/We agree that you may proceed against me without first proceeding against our
company. I/We agree that a waiver or release of rights against our company will not discharge my/our obligation to pay. I/We agree to pay
additional sums as the court may adjudge reasonable for attorney fees allowed in any lawsuit filed to collect past-due invoices. I/We agree to pay
late charges of 1.5% per month (18% per annum) on all invoices past due.
SIGNATURES
Guarantor Signature
Guarantor Signature
Name
Name
Date
Date
Page 3 of 3