Wholesale Application — Bellegarde Bakery

WHOLESALE NEW PARTNER FORM

Primary Contact Info

Name & Title

Phone

(###)

###

####

Email

General Information

Legal Business Name

Delivery Address

Tax ID

Resale #

(*if applicable)

Accounts Payable Contact

Name

First Name

Last Name

Phone

(###)

###

####

Email

Business Information

Type of Business

(store front, restaurant, etc.)

Authorized Purchaser(s)

Payment Terms

Payment Method