Credit Application

Salesperson Number*
Legal Name of Company or Individual*
DBA or Trade Name (if different than legal name)
Business Address*
Street Address Address Line 2 City State ZIP Code
Business Phone*
Business Fax
Email Address*
Delivery Address*
Street Address Address Line 2 City State ZIP Code
Billing Address (if different than business address above)
Street Address Address Line 2 City State ZIP Code
Business Type*
- Sole Proprietorship
- Partnership
- Corporation
- Not For Profit
Date Business Opened/Purchased (mm/dd/yyyy)*
Federal Tax ID #*
Do you have tax exempt status?*
- Yes
- No
Tax Exempt #
Please attach a copy of your tax exempt certificate
Liquor Licence #
If partnership or corporation, list partners/officers and titles
Name Title

Owner of Business*
First Last
Owner's Home Address*
Street Address Address Line 2 City State ZIP Code
Owner's Home Phone Number*
Owner's Social Security Number*
Manager of Business*
First Last
Owner of Building*
Building Owner's Address*
Street Address Address Line 2 City State ZIP Code
Accounts Payable Contact*
First Last
Accounts Payable Address*
Street Address Address Line 2 City State ZIP Code
Accounts Payable Email*
Accounts Payable Phone Number*

First Trade Reference
Reference Name*
Reference Location*
City State
Reference Phone Number*
Reference Fax Number
Second Trade Reference
Reference Name*
Reference Address*
City State
Reference Phone Number*
Reference Fax Number
Third Trade Reference
Reference Name*
Reference Address*
City State
Reference Phone Number*
Reference Fax Number

Bank Information
Bank Name*
Bank Address*
Street Address Address Line 2 City State ZIP Code
Bank Phone Number*
Bank Fax Number
Bank Account #*
Bank Account Type*
- Checking Account
- Savings Account
Loan #
Personal Bank
Bank Name*
Bank Address*
Street Address Address Line 2 City State ZIP Code
Bank Phone Number*
Bank Fax Number
Contact Person*
First Last

Terms of Credit
A. It is understood that the amount of credit received can be increased without applicant signing a new application for credit, and upon receiving additional credit, applicant agrees that they will be bound to all of the terms and obligations of this agreement, as if the new amount of credit received was the amount of credit initially requested. B. For any and all outstanding invoices paid with a charge card, additional fees may apply. Charge card fees will be added after invoice is created. C. Terms If any amount due Seller is not paid when due a delinquency charge shall be added to the amount due. Applicant by signing this application specifically consents to the said delinquency charge below. Should Upper Lakes Foods, Inc. begin a collection action to recover the cost of product delivered and received by applicant but not paid for pursuant to the terms of this credit arrangement, said applicant agrees that all costs of collection including but not limited to reasonable attorney fees, filing fees, etc. shall be the sole responsibility of said applicant. Further any amount due seller that is not paid when due a delinquency charge shall be added to the amount due. Said delinquency charge shall be added to that amount due. Said delinquency charge shall be 12% per annum or maximum allowed by state statute. Applicant by signing this application consents to the delinquency charge.
Personal Guarantee*
- I hereby personally guarantee(s) payment of any obligation of the above applicant including any additional credit extended to the applicant over and above the amount initially requested by the applicant. I further consent(s) and authorize(s) Upper Lakes Foods, Inc. to obtain a Credit Report.
Authorization*
- I/We accept and agree to all terms and conditions set out in this credit application. I/We hereby authorize Upper Lakes Foods, Inc. to review my/our references, credit and financial responsibility.
Your Name*
First Last
Your Phone Number*

Step 1 of 5

First Trade Reference

Second Trade Reference

Third Trade Reference

Bank Information

Personal Bank

Terms of Credit