Please note that strawberries are in short supply as we transition from the California growing season to Florida. 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 Sales Person Date MM DD YYYY Trade Name * Full Legal Name of Business * Street Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Business Telephone * (###) ### #### Fax (###) ### #### Owner's Email * Owner's Cell Phone (###) ### #### Checkbox Independent Proprietorship Corporation Partnership LLC Date Business Opened MM DD YYYY Federal Tax ID# Is Billing Address the Same as Shipping Address * Yes No If No, What is the Billing Address? Address 1 Address 2 City State/Province Zip/Postal Code Country Hours of Operation Preferred Delivery Times * Delivery Location & Special Instructions * Purchasing Agent or Manager's Name First Name Last Name Email Address Cell Phone Number (###) ### #### Accounts Payable Contact Name First Name Last Name Contact Phone (###) ### #### Fax Number (###) ### #### Email Address Credit Terms Requested: C.O.D Credit Terms * 7,14,21 or 30 days Pay By Credit Card * Yes No Bank Name Account Number Address Address 1 Address 2 City State/Province Zip/Postal Code Country Account Manager First Name Last Name Phone Number (###) ### #### Trade References No liquor companies, restaurant related only. Please provide the name, phone number, facsimile and account number of three references. 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. First Name Last Name Title Date MM DD YYYY Letter of Authorization Name * I hereby authorize Belair Produce, Inc to charge to following credit card First Name Last Name Account Name * Phone Number * (###) ### #### Email * Type of Card * Visa Mastercard Credit Card Holder * Credit Card Number * Authorization Code * 3 digits on the back of the credit card. Expiration Date * MM DD YYYY Name of Bank Billing Address Address 1 Address 2 City State/Province Zip/Postal Code Country 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. First Name Last Name Date * MM DD YYYY Cardholder's Signature * First Name Last Name Personal Guarantee Business Name: * 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 Trading As: * Consent to any extension or indulgence granted 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. Corporation * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Name(s) of Authorized Signature(s) * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Signature * First Name Last Name Social Security Number * Name(s) of Authorized Signature(s) First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Signature First Name Last Name Social Security Number ABOUT US | OUR PRODUCTS | KITCHEN SPOTLIGHT | CLIENT APPLICATION | TERMS & CONDITIONS | CONTACT US | EMPLOYMENT APPLICATION BELAIR PRODUCE 7226 PARKWAY DRIVE, HANOVER, MD, 21076, UNITED STATES 410-782-8000 MANAGEMENT@BELAIRPRODUCE.COM SUBSCRIBE TO OUR NEWSLETTER Sign up with your email address to receive news and updates! SIGN UP Designed By Lt Grey Creative