Credit Application

Credit Application
Mina Foods, Inc

ACCOUNT SETUP FORM
Sales & Use tax form must be printed, signed, and sent into us via email or fax.

FAX: 203-874-8282 email: peter@minafoods.com
or attach file below
SALES & USE TAX Resale Certificate upload
Mina Sales Rep Name *
Type none if you do not have one
Trade Name/DBA *
Corporate E *
Ship to Address *
Include City, State, Zip
Contact *
email *
Phone Number *
Fax Number
State Tax Registration # *
Liquor Licence *
Type none if you do not have one
A/P Name *
Company Type *

Individual Partnership LLC Corporation
Location Type *

Rent Lease Own
Date of Incorporation *
State Incorporated *
Name of Banking Institution *
Account # *
Bank Contact Name
Delivery Hours *
What hours do you wish to receive our deliveries
Owners Name/s *
Drivers License #
Social Security #
Home Address
include street, city, state, and zip code
Phone number
Best way to get a hold of you

Terms
Applicant's signature attests to financial responsibility, ability, and willingness to pay our invoices in accordance with the following terms:
1. I/We authorize all banking and trade references to release information to Mina Foods, Inc. for its confidential use
2. I/We agree to notify Mina Foods, Inc. immediately of any change of ownership
3. All Product returns must be authorized and all shorts must be notified within twenty four(24) hours of delivery.
4. All returned checks are subject to a service charge.
5. Standard credit terms are seven (7) days from date of purchase.
6. All invoices will be paid according to our stated terms, otherwise they will be considered delinquent and may be placed for collection.
7. IF THE ACCOUNT BECOMES DELINQUENT, I ACKNOWLEDGE AND AGREE TO PAY ALL COLLECTION COSTS, ATTORNEY'S FEES, COURT FEES AND INTEREST OF 1.5% MONTHLY.
In consideration of Mina Foods, Inc. (Seller) selling good, wares, and merchandise upon credit or allowing additional time for payment on the present indebtedness, I hereby personally guarantee payment of any and all obligations incurred and agree to personally pay the said obligations, in accordance with the term between the parties, in the event of default.
Signature *

First Name Last Name
Date *

Month Day Year
Partner Signature

First Name Last Name
Date

Month Day Year

Delivery Instructions
Name of Business *
Owners Name *
Manager's Name *
Telephone *
Shipping Address *
Number of Deliveries wanted per week *
Earliest possible Delivery time *

: Hour Minutes AM/PM Option
Latest delivery time *

: Hour Minutes AM/PM Option
Stairs *

Up Down Same Level
How many stairs
Area of delivery *

Dock Delivery Pallet Delivery Street Delivery Side Door Delivery Front Door Delivery Rear Door Delivery
Special Delivery Instructions
E-mail
Should be Empty:

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Mina Foods, Inc