Customer Application

Download the necessary form or fill out the following application, then fax back to (650) 583-2676
DOWNLOADS: Customer Application

Company Information
* - Denotes a Required Field


Company Name:
Telephone Number*:
Fax Number*:
Billing Address:
City:
State:
Zip:
Social Security # or FID #*:
Years in Business:
Area(s) You Service:
Type of Business: Corporation | Partnership | Proprietorship
Other:

 

Company Contacts Information


Contacts Name:
Telephone Number:
Email*:

 

Accounts Payable Information


Contacts Name:
Telephone Number:
Fax Number:
Email:

 

Trade References


Company Name*:
Telephone Number:
Fax Number*:
Address:
City:

Zip:

Company Name*:
Telephone Number:
Fax Number*:
Address:
City:
State:
Zip:

Company Name*:
Telephone Number:
Fax Number*:
Address:
City:
State:
Zip:

 

Bank References


Banks Name:
Telephone Number:
Fax Number*:
Address:
City:
State:
Zip:
Account Number:
Name on Account:

 

CUSTOMER AGREEMENT

Attention! There is 1 more step in the process. Please print these forms. After doing so please sign and date the forms and fax them to the Asian Food Grocer Customer Service Department at (650) 583-2676.

By submitting these forms the applicant authorizes Asian Food Grocer to obtain information from the bank and trade references listed above. I understand and agree that Asian Food Grocer terms of sale are NET 30 days. I agree to pay a service charge of 1.5% per month on all past due amounts on any customary and reasonable collections costs which may be incurred.

Your trade references require your permission in order to give out any information. By submitting this form you authorize Asian Food Grocer to use your information.



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Today's Date *