Place Order

Wholesale Application

ACCOUNT IDENTIFICATION:
Business Name:		Telephone No.:
Business Address:
City:		State:  Zip:
Check if use same address for mailing
Mailing Address:
City:		State:  Zip:

BUSINESS IDENTITY:

IndividualPartnershipCorporation

PROPRIETORSHIP – PARTNERSHIP INFORMATION:
Federal Tax ID: DUN Number: Year(s) in business: Ever filed for bankruptcy? YesNo
Owner 1 Name: Home Address: City: State: Zip: Home Phone: Social security No.:		Owner 2 Name: Home Address: City: State: Zip: Home Phone: Social security No.:

TRADE REFERENCES:
Business Name:		Contact Name:
Address:		Tele No.:
Business Name:		Contact Name:
Address:		Tele No.:
Business Name:		Contact Name:
Address:		Tele No.:

BANK REFERENCES:
Name:		Tele No.:
Address:
Checking acct No.:		Date account opened:

TERMS AND CONDITIONS:

All wholesale accounts are C.O.D. until credit is established. Authorization is hereby given to United Bakery & Company to contact the above furnished references in order to make a determination on extending credit terms.

By:

Title:

Date:

(*Required Field )