Fresh Mark, Inc. Credit Application

Business Name		Phone
Business Address		Fax
Shipping Address		Year Est.
		County
City	State	Zip Code

Billing Address:	Name
	Phone
	Fax
	Address
	City	State Zip Code:

Type of Business

Title

Name

Premises:

Premises Owner

Address

City

State

Zip Code

Bank References:
Bank Name			Checking Acct. #
Address			Phone #
City/State/Zip			Person to Contact
Bank Name			Checking Acct. #
Address			Phone #
City/State/Zip			Person to Contact

Trade References:
Name	Address	City/State/Zip	Phone #

I authorize the above entities to release financial information for Fresh Mark's confidential use in establishing credit. Yes No

Fresh Mark Terms

Weekly (Net 7): Payment due 7 days from date of invoice.

Financial Information

Credit Agency that Your Company Uses (i.e. D&B,F&D,Etc.) Account Number

If your company does not provide financial information to a credit agency, please submit your company's most recent audited financials with this credit application.

Person submitting:

Name

E-mail

Title

Date

Comments

By checking this box you are ackowledging that the information contained in this credit application is accurate
and complete and that you are authorized to submit this application on behalf of your organization.

		Credit Application	Help
Phone: (330) 832-7491	Fax: (330) 830-3174	We are submitting the following information for the confidential use of the Credit Department for the purpose of establishing credit terms with Fresh Mark, Inc. We agree to adhere to the terms established and will remit payments accordingly.
www.freshmark.com