Wholesale Customer Intake

Wholesale Customer Intake Form

Company Info

* Indicates required field

Company Name *

Trade Name(s) or "DBA" *

Date Business Opened *

Owner Name *

First

Last

Owner Phone Number *

Owner Email *

Ownership Structure *

Buyer Info

Buyer Contact Name *

First

Last

Buyer Email *

Buyer Phone Number *

Food Delivery Address *

Line 1

Line 2

City

State

Zip Code

Country

Accounting Info

A/P Contact Name *

First

Last

A/P Email *

A/P Phone Number *

Billing Address *

Line 1

Line 2

City

State

Zip Code

Country

Business/Trade Reference

Company Name *

Name *

First

Last

Email *

Phone Number *

Nature of Business Relationship *

Terms Agreement

The above-named Applicant hereby applies to purchase products on credit/COD from the Valley Roots Food Hub ("VRFH”). If credit is extended, Applicant agrees to the following terms and conditions:

1. All orders are C.O.D. unless otherwise approved.
2. All VRFH invoices are payable according to the terms given. Any account with past due balances will be placed on credit hold until payment is received and account balance is current. Credit terms may be reinstated at VRFH’s sole discretion, which may require a new credit application and additional documentation for consideration.
3. All invoices are payable to: Valley Roots Food Hub, PO Box 35 Mosca, CO 81146
4. All product returns/credits must be authorized in advance by the VRFH management staff at 719-588-8245 or [email protected] and be accompanied by the full and unused product. Product returns, claims or shortages will not be allowed after 24 hours of receipt of goods.
5. An account is delinquent and in default if it is not paid according to terms. A delinquency charge of 2% per month on the unpaid balance will be charged on all delinquent accounts. There is also a $30 return payment fee for declined or insufficient funds (NSF) checks.
6. In the event of default, all costs of collection, including attorney’s fees and court costs, shall be paid by the Applicant.
7. VRFH must be notified in writing in the event of change of ownership or bankruptcy, upon which credit terms may be discontinued in VRFH’s discretion.
8. The person executing this agreement on behalf of the Applicant warrants and represents that he or she has authority to bind the Applicant and is authorized by the Applicant to submit this credit application and to agree to these terms and conditions. By submitting this application, Applicant accepts financial responsibility, and represents that it has the ability and willingness to pay all invoices according to their terms.
9. The undersigned hereby represents that the information provided is complete and accurate and that VRFH will rely upon the information to make the credit decision.
10. The terms of credit can be modified only in writing. A facsimile of this application is valid as an original. In the event of dispute, the laws of the state of Colorado shall apply. The Applicant consents to jurisdiction and venue to resolve all disputes in the Colorado state courts in Alamosa County, Colorado.

Agree to Terms *

Yes No

Additional Info/Notes *

I agree to receiving marketing and promotional materials

Agree + Submit

New Customer Intake