FOOD WHOLESALERS

701 46th Street South

St Petersburg, FL 33711

Telephone (727) 321-2514

Fax 727-327-7427

CREDIT APPLICATION - CHECK CARD not outside of Frorida

Legal Name of Firm or Individual                            Doing Business as

                   __________________________________________     _____________________________

Street address or P.O. Box  _________________       City, State, Zip _____________________________

Type of Ownership    Corporation      Partnership         Proprietorship

Name of Principal  ______________________________                                              

Home Address   ___________________________________

Home Phone  _________________

Name of Principal  ___________________________

Home Address  ____________________________________

Home Phone  _________________________________

 

If corporation: State Incorporated ________________

Resident Agent Info: Name __________________________      Address________________________

Telephone__________________________

Kind of Business______________________

How long in Business under present owner?  _______________                                                    

Building    Own        Lease

 

Name of Bank_____________________

Address____________________________

City and State_____________   ___________

 

Account Officer __________________________                                         

_ Account Number ____________________                 Phone Number___________________________

 

Information obtained from                                             Position                                                                             Individual Personal Guaranty

I / we personally guarantee to Food Wholesalers, Its Successors or assigns, full payment of all indebtedness of:

 

Name   ____________________________              Corporate Name  ________________________

This guarantee will remain in full force and effect, until written notice of its termination is received by Food Wholesalers. Notice shall be sent Certified Mail: Return Receipt.

It is further agreed that all reasonable costs, associated with the collection of this amount shall be borne by purchaser.

 

 

Guarantor Signature  ____________________Date_______      Guarantor_______________  Date

 

Home Address ________________________                     ___________________________________

 

Driver License #___________________________

 

Driver License #____________________________

 

 

Must be completely fill out or credit will not be extended. Driver license # required for Checks . Suppliers                                            Address                                  Telephone