Step 1 of 12 8% Customer InformationCompany NameDBA or Trading As:Physical Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Billing Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone NumberFax Number Business Credit InformationFederal Tax ID # / SS #PACA License #Years Business EstablishedYears at Current LocationEstimated Sales per MonthCredit Dollar Amount RequestedIf Affliate/Subsidiary, Indicate ParentNumber of EmployeesAnnual Sales VolumePurchasing AgentDate of IncorporationState of Incorporation AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State OwnershipName First Last Email Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneSocial Security NumberDriver's License NumberCompany Type Sole Proprietorship Partnership Corporation Limited Liability Entity Franchisee Name(First Partner) First Last Email Address(First Partner) Home Address(First Partner) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone(First Partner)Social Security Number(First Partner)Driver's License Number(First Partner)Name of President First Last Name of Vice President First Last Name of Treasurer First Last Name of Accounts Payable Contact First Last Accounts Payable Phone NumberAddress of Principal Office Same as above Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Principal Office Phone Number Trade ReferencesTrade ReferencesNameAddressPhoneEmail Add Remove Bank ReferencesBank ReferencesNameAddressPhoneEmail Add Remove Authorization for Credit ReportCredit Report - AuthorizationThe undersigned is executing this Authorization for Credit Report individually for the purpose of authorizing Seller to obtain a consumer credit report from time to time on the undersigned through credit and reporting agencies or other sources in order to further evaluate the credit worthiness of such individual in connection with the credit evaluation process and the extension of business credit to Customer. The undersigned, as an individual, hereby knowingly consents to the use of such credit report in connection with the fair credit reporting act as contained in 15 U.S.C. § 1681, et seq., as amended from time to time. I agree.Name First Last SignatureDate MM slash DD slash YYYY Continuing Personal GuaranteeContinuing Personal Guarantee - AuthorizationIn consideration for the extension of credit to Customer by Seller the undersigned, personally, jointly and severally, guarantee payment of all past, present, and future indebtedness of Customer to the Seller as the same may be renewed, extended or rearranged from time to time. This guarantee is an absolute, unconditional, complete and continuing one and is made without reliance on any representations by Seller, or anyone acting on its behalf, whether explicit or implicit, made orally or in writing, regarding the subject matter of this Agreement. Guarantor(s) waive notice of acceptance and reliance on this guaranty, notice of sales to Customer or any liabilities or obligations incurred by Customer, notice of default by Customer, and notation of nonpayment with respect to the obligation covered under the guarantee. Guarantor further waives any defenses or other circumstance which might otherwise constitute a defense to this guarantee. This guarantee is binding upon the undersigned, their heirs, personal representatives and successors, and shall inure to benefit of the Seller, its successors and assigns. The undersigned shall pay all costs of collection, including accrued interest, court costs, collection agency fees, and reasonable attorneys’ fees, all of which shall be considered sums owing in connection with the underlying transactions under the PACA trust, as applicable. All payments which become due under the terms of this Agreement shall be made at Seller's office or at an address otherwise designated by Seller in writing. Seller may waive or release collateral or other guarantors, without notice to or consent of the undersigned. This guarantee shall be governed and construed under the laws of the State of Indiana. Any actions arising under this guarantee shall commenced in the State or Federal Courts having jurisdiction over Indianapolis, Indiana, and Guarantors hereby consent to the jurisdiction of said courts for all purposes. I agree.First Guarantor Name First Last SignatureHome Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneSocial Security NumberEmail Second Guarantor Name First Last SignatureHome Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneSocial Security NumberEmail Address Credit Terms and PolicyCredit Terms Consent 1Customer warrants and represents that all information provided in this Credit Application and Agreement (“Agreement”) is true and correct to the best of Customer's knowledge. Customer acknowledges that FreshEdge, LLC, on its own behalf and on behalf of its subsidiaries and affiliates meaning those entities under the control of FreshEdge, LLC, or directly or indirectly under common control by the entities or persons that control FreshEdge, LLC (collectively hereinafter and above, “Seller”) will rely on the information provided herein by Customer in determining whether to extend credit to Customer. The decision to extend credit to Customer shall be made by Seller in its sole and exclusive discretion, and Seller may refuse to extend credit to Customer for any reason, or no reason at all, and at any time without prior notice to Customer, except as required by law. This Agreement is not binding upon Seller unless approved by Seller in writing. If approved, this Agreement shall apply to all invoices or other documents evidencing Customer’s obligations to Seller, all of which are incorporated herein by reference. Customer agrees that Seller is not subject to any terms and conditions set forth in any purchase order confirmation or other communication from Customer that would supplement or modify this Agreement. Customer agrees that Seller is not responsible for failure to deliver to Customer any product in any quantity, quality or price, unless noted on the original delivery receipt at the time of delivery or unless Seller is specifically notified in writing of the nonconformity within twenty-four hours of delivery. Customer agrees to pay all invoices within the terms approved by Seller. A $25.00 charge shall be assessed by Seller in the event any checks are returned by Customer’s bank. Failure to remain within terms could result in the Customer's account being placed on C.O.D. terms until the entire balance is paid and may further subject Customer's account to the accrual of interest on any unpaid balance at either the rate of 1.5% per month or the maximum rate permitted by law. Customer shall be liable for any deficiency after repossession and sale. In the event of default, Customer shall pay all costs of collection, reasonable attorneys’ fees, court costs and collection agency fees. Costs of collection, including reasonable attorney's fees, court costs, pre-judgment interest and collection agency fees shall be considered sums owing in connection with the underlying transactions under the PACA trust, 7 U.S.C. § 499e, as applicable. Seller’s failure to demand strict compliance with the terms of this Agreement shall not be construed as a waiver of any of Seller’s rights at law or which arise under this Agreement. This Agreement shall be governed and construed under the laws of the State of Indiana. Any actions arising under this Agreement shall commenced in the State or Federal Courts having jurisdiction over Indianapolis, Indiana, and Customer hereby consents to the jurisdiction of said courts for all purposes. I agree.Name First Last SignatureDate MM slash DD slash YYYY Product Recall InformationIn the event of any incident, product withdrawal, or product recall, Seller shall contact the individual identified below.Name First Last TitleMobile Numbers Add RemoveEmail Addresses Add Remove Sales and Use Tax ExemptionName of Customer First Last Tax IdentifierSales and Tax Use Exemption - ConsentCustomer hereby warrants and represents that it is exempt from payment of sales and use taxes for the purchase of taxable items delivered to Customer from Seller from time to time. Customer claims this exemption for the following reason: I understand that Customer will be liable for payment of all state and local sales or use taxes which may become due for failure to comply with the provisions of the Tax Code and/or all applicable law. I further understand that it is a criminal offense to give an exemption certificate to Seller for taxable items that I know, at the time of purchase, will be used in a manner other than as expressed in this certificate, and may be subject to criminal fines or punishment according to law. I agree.SignatureTitleDate MM slash DD slash YYYY Logistical InformationReceiving HoursOperating HoursStack HeightPO Box # required for all orders Yes No Delivery Appointment Required Yes No Space for Use by Seller OnlyCredit LimitTerms GrantedCopy of W-9 Received Yes No Copy of Driver's License Received Yes No Notes