Golden Mills Credit Application – A1 American – Quality Service Value – Since 1911

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Corporate Headquarters
140 Cecil Court
Fayetteville, GA 30214

800-940-5997
800-453-0952
sales@goldenmills.com
goldenmills.com

Golden Mills Credit Application

Date
Date Format: MM slash DD slash YYYY
Company Legal Name:*
Doing Business As:*
Phone:*
Ext:
Fax:
Billing Address:*
Street Address Address Line 2 City State ZIP Code
Shipping Address:
Same as Above

Street Address Address Line 2 City State ZIP Code
Parent Company Name:
Address:
Street Address Address Line 2 City State ZIP Code
Name of Affiliated Companies:
Address:
Street Address Address Line 2 City State ZIP Code
Check One:
- PROPRIETORSHIP
- CORPORATION
- PARTNERSHIP
- OTHER
If OTHER, please specify:
Desired Credit Limit:*
Business Start Date:
Date Format: MM slash DD slash YYYY
State of Registration:
Federal Tax ID No:
Type of Business:
Sales Tax Exempt?
- Yes
- No
If Yes, please attach valid Sales Tax Certificate
Do You Require a Purchase Order?
- Yes
- No
COMPANY CONTACT INFORMATION
Primary Company Contact:
Phone:
Ext:
Fax:
Email:
Accounts Payable Contact:
Phone:
Ext:
Fax:
Email:
CORPORATE OFFICERS, MEMBERS, PARTNERSHIP OR PROPRIETORSHIP INFORMATION
Principal’s Name:
Title:
Principal’s Name:
Title:
Principal’s Name:
Title:
Principal’s Name:
Title:
BANK REFERENCE INFORMATION
Bank Name:
Contact Name:
Phone:
Ext:
Address:
Street Address Address Line 2 City State ZIP Code
Checking Account #:
Saving Account #:
COMPARABLE VENDOR REFERENCE INFORMATION
Vendor Name:
Account #:
Address
Street Address Address Line 2 City State ZIP Code
Phone:
Ext:
Fax:
Vendor Name:
Account #:
Address:
Street Address Address Line 2 City State ZIP Code
Phone:
Ext:
Fax:
Vendor Name:
Account #:
Address:
Street Address Address Line 2 City State ZIP Code
Phone:
Ext:
Fax:
W-9 Form
DOWNLOAD W-9 FORM HERE

*PLEASE NOTE: You must download, complete, sign, and upload the W-9 document with this credit application. Any application without a W-9 form will not be processed.
W-9 File Upload*
TO BE READ AND COMPLETED BY ALL APPLICANTS
Has the Applicant filed for bankruptcy, or been the subject of an involuntary bankruptcy petition, in the past 10 years?
- Yes
- No
Have any unsatisfied judgment(s) been entered against Applicant in the past 7 years?
- Yes
- No
Have any tax lien(s) been filed against the Applicant in the past 7 years?
- Yes
- No
If the answer to any one or more of the foregoing questions is “yes”, please attach an explanatory statement.
APPLICANT CERTIFICATION.
By signing below, (a) I, on behalf of my business (the “Applicant”), hereby request credit from the company(ies) selected above (each, a “Creditor”) for the purpose of financing the Applicant’s purchase of goods from Creditor; (b) I authorize Creditor to investigate the Applicant’s creditworthiness, including without limitation by obtaining credit reports and other information, and to share such information with any Creditor or affiliate of a Creditor or any third party in connection with this application or any credit extended by Creditor to Applicant; (c) I authorize all of Applicant’s past and present banks, lenders, lessors, landlords, trade creditors and other creditors to provide Creditor or its designee with any and all information that will assist Creditor in its credit inquiry; and (d) I certify that all information provided in this application about the Applicant and myself is accurate and complete. This application is given for the purpose of obtaining credit. Applicant agrees that, if credit is extended in response to this application, the terms and conditions applicable to such credit shall be as set forth in between Applicant and Creditor(s), and may be amended from time to time.

OFFICER/PARTNER CERTIFICATION. By signing below, (a) I certify that I am authorized on behalf of the Applicant to apply for credit for the Applicant, and (b) I authorize Creditor to verify credit and other information about me relevant to this application, and to obtain consumer report(s) about me from consumer reporting agencies.

GUARANTOR AUTHORIZATION. By signing below, (a) I certify that all of the information about me provided in this application is accurate and complete, and (b) I authorize Creditor to verify credit and other information about me relevant to this application, and to obtain consumer report(s) about me from consumer reporting agencies.

IMPORTANT LEGAL NOTICES The term “me” in these Notices refers to an officer or guarantor of Applicant, who has signed this application, or to the Applicant if Applicant is a sole proprietor who has signed this application, or to a partner in Applicant who has signed this application if Applicant is a partnership.
Company Name
STATEMENT OF TERMS

Seller establishes, in the name of the applicant, subject to approval, an open account for the purchases of goods from Seller in accordance with the terms and conditions listed below. The terms set forth herein shall apply to sales from any Golden Mills Products, and shall continue until the undersigned cancels this agreement in writing. The Undersigned authorizes any bank, credit reporting agency, or credit references to release Undersigned’s individual and/or company credit information to Seller. Seller may check credit references as often as it deems necessary. The Undersigned expressly agrees to pay interest/finance charges on any past due amounts at the rate of 1.5% per month. The Undersigned further agrees to pay all reasonable collection costs and/or court costs and/or attorney fees incurred in connection with the collection of this account. Merchandise returned is subject to a 15% restocking fee, and all merchandise tendered for return is subject to inspection. No credit will be allowed for damaged, mutilated, altered, obsolete, or otherwise unsaleable merchandise.
Print Name:*
First Last
Signature*
(OFFICER/PARTNER/MEMBER/SOLE PROPRIETOR)

ELECTRONIC SIGNATURE AGREEMENT - by signing this credit application agreement, you will be entering into an electronic agreement, evidenced by an electronic record. You will also be consenting to the use of an electronic signature to manifest your agreement to the terms and conditions in the credit application terms. This consent is limited to that particular transaction and does not apply to any future transactions entered into by you and Golden Mills. You must electronically acknowledge that you have read these disclosures and agree to all terms.
Date*
Date Format: MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.

Locations

Corporate Headquarters

12386 Osborne Place, Pacoima, CA 91331
1-833-205-2200

East Coast Office

140 Cecil Court, Fayetteville, GA 30214
1-833-205-2200

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