Account Application – CA Save time by submitting your application through sevenfifty.com with just a few clicks. Account Application - CA ACCOUNT PROFILEMassanois SalespersonLeave blank if you are contacting us for the first time.License (Corp.) Name:*DBA:*ABC License #:*Expiration Date:* Date Format: MM slash DD slash YYYY Federal Tax ID #:*Delivery Address:* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Please enter the address where we can direct all deliveries.Billing Address:* Same as delivery address Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Please choose a 4-hour delivery window*9am - 1pm10am - 2pm11am - 3pm12pm - 4pm1pm - 5pmAdditional Delivery Instructions:i.e. Freight entrance on 29th St, ring bellPRIMARY CONTACTEnter the information for the primary contact (buyer) of your business.Name:*Title:*Email:* Business Phone:*Mobile:PRINCIPAL/PARTNER CONTACTName:* First Last Phone:ACCOUNTS PAYABLEName:*Email:* Business Phone:*Mobile:BANK INFORMATIONAfter this form is submitted, Massanois will contact your business directly to gather bank and routing information.TRADE REFERENCESPlease list two industry-related references.Reference 1:* First Last Company Name:Phone:Reference 2:* First Last Company Name:Phone:CONFIRMATION/SIGNATUREAccount applicant, hereafter known as the buyer, in consideration of obtaining purchases on credit from Massanois, hereinafter known as the seller, hereby agrees to the following: buyer agrees to honor all terms and conditions of most current price list and invoices, and assumes all responsibility for attainment of said information. If this application is executed by a corporation, it includes any and all successor in interest of said corporation and is binding on the same and all successors in interest, now and in the future. In the event of any delinquency of any account, buyer agrees to pay all collection costs, attorney fees and court costs in the collection of said account. Buyer consents to the venue and jurisdiction of any court located in New York County, NY. Buyer agrees that in the event the buyer issues a check which does not clear the collection process, a $25.00 fee shall be added to the buyer’s indebtedness.Print Name of Applicant:*Signature:*
