Belair Produce New Customer Application

Please fill out and submit all three forms to have your application reviewed as a new customer. If you have any questions please call the office at (410) 782-8000 | Terms & Conditions


 

Customer Application

Date
Date
Street Address *
Street Address
Business Telephone *
Business Telephone
Fax
Fax
Owner's Cell Phone
Owner's Cell Phone
Checkbox
Date Business Opened
Date Business Opened
Is Billing Address the Same as Shipping Address *
If No, What is the Billing Address?
If No, What is the Billing Address?
Purchasing Agent or Manager's Name
Purchasing Agent or Manager's Name
Cell Phone Number
Cell Phone Number
Accounts Payable Contact Name
Accounts Payable Contact Name
Contact Phone
Contact Phone
Fax Number
Fax Number
C.O.D
7,14,21 or 30 days
Pay By Credit Card *
Address
Address
Account Manager
Account Manager
Phone Number
Phone Number
No liquor companies, restaurant related only. Please provide the name, phone number, facsimile and account number of three references.
Belair Policy Statement Signature *
Belair Policy Statement Signature
The undersigned attest that they are an Owner, Partner, or Officer or Authorized Agent and hereby request Belair Produce, on behalf of applicant to establish a business account and extend credit to Applicant, subject to the terms and conditions established by Belair Produce and by PACA Trust Provision (Perishable Agricultural Commodities Acts) which are set forth on the attached hereto. Applicant agrees to be bound by said terms and conditions.
Date
Date

Letter of Authorization

Name *
Name
I hereby authorize Belair Produce, Inc to charge to following credit card
Phone Number *
Phone Number
Type of Card *
3 digits on the back of the credit card.
Expiration Date *
Expiration Date
Billing Address
Billing Address
Disclosure *
Disclosure
Amount of the balance of my account with Belair Produce Inc. every week will be charge. If for any reason my card is declined, I agree to pay 2.9% re-processing fee(s) to Belair Produce Inc., Purchases made by the above account are to be charged to the credit card listed.
Date *
Date
Cardholder's Signature *
Cardholder's Signature

Personal Guarantee

To induce Belair Produce Inc. to sell merchandise, extend credit, or continue doing either to the below named customer, the undersigned jointly and severally guarantee full payment for all products sold or to be sold to
Waive prior recourse and notice of non-payment.Should any payment not be made when due, the undersigned authorize any attorney designated by Belair Produce, Inc. to appear in any court of competent jurisdiction and confess judgment against them for the amount due with costs of suit, Interest at twenty four percent (24%) per annum, and including, but not limited to, all attorney fees, waiving homestead and all other exemptions, stay of execution, and right of appeal. Should the authorization for confession of judgment be deemed invalid, the remaining provisions of this instrument shall remain in full force and effect.
Address *
Address
Name(s) of Authorized Signature(s) *
Name(s) of Authorized Signature(s)
Address *
Address
Signature *
Signature
Name(s) of Authorized Signature(s)
Name(s) of Authorized Signature(s)
Address
Address
Signature
Signature