Credit Application

1 Basic Information

2 Company Information

3 Bank Information

4 Trade References

5 Terms and Conditions of Sale

Basic Info
Company Name*
Phone Number*
Billing Address*
Street Address City State ZIP Code
Shipping Address
- Same as Billing
Shipping Address
Street Address City State ZIP Code

Company Information
Federal ID*
Sales Taxes Exemption*
Type of Business*
Years Established*
Owner/Administrator Name
Owner/Administrator Name*
Title*
Email*
Phone*
More Owners/Administrators
- Add more Owners/Administrators
Owner/Administrator Name #2
Owner/Administrator Name #2
Title
Email
Phone
Owner/Administrator Name #3
Owner/Administrator Name #3
Title
Email
Phone

Bank Information
Bank Name*
Account Number*
Contact Name
Phone Number
Fax Number

Trade References
Business Name*
Owner/Administrator*
Address
Street Address City State ZIP Code
Trade References
- More Trade References
Owner/Administrator #1
Business Name
Owner/Administrator
Address #1
Street Address City State ZIP Code
Owner/Administrator #2
Business Names
Owner/Administrator
Address #2
Street Address City State ZIP Code

Terms and Conditions of Sale
All sales are prepaid until credit has been approved. All invoices are due net 30 days of invoiced date. Customer agrees to pay a 1% service charge per month for all overdue invoices. Customer also agrees to pay any and all collection expenses as well as any court costs necessary to effect the collection of these past due invoices.

All orders are accepted under the following conditions; Liability is not assumed by seller for the delay or failure to deliver due to weather or any other condition beyond seller’s control (ie. floods, strikes, etc.) Seller will take great care to insure that all plants are true to name and seller gives no warranty expressed or implied as to the merchantability or fitness for any particular use of it’s stock.

All claims for shipping damage must be made within 48 hours of receipt of merchandise.

The above information was given for the purpose of obtaining credit and is warranted to be true. I/we hereby authorize Roseville Farms L.C. to investigate the references listed above which pertain to my/our credit and financial responsibility.

Applicant’s signature attests financial responsibility, ability and liability to pay Roseville Farms L.C. invoices and service charges in accordance with terms and conditions stated above.
Company Name*
Type of Business*
- Partnership
- Corporation
- LLC
Type Your Name*
By typing your name in the box above, your are electronic signing the form upon submission.
Signature*
- By checking this you agrees the names your are typing in the box above counts at your electronic signature.
Title*

Download and Fax back

Don’t have time to fill out the form now? You can download, fill out the form and fax it back to us at 407-884-1650.

Click here to download the PDF Credit Application.

Basic Info

Company Information

Owner/Administrator Name

Owner/Administrator Name #2

Owner/Administrator Name #3

Bank Information

Trade References

Owner/Administrator #1

Owner/Administrator #2

Terms and Conditions of Sale

Download and Fax back