Business Name: ______ Years in Business: ______
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Amcafé USA LLC, Specialty Coffee Importer.A Finagra Co
Tel: (914) 576 – 2533, Fax 914-347-6823, Email:[email protected]
5 West Main Street. Suite 203,Elmsford,NY 10523
Business Name: ______Years in Business: ______
DBA: ______Tel.______Fax______
Billing Address: ______
Delivery Address: ______Email Address______
___ Proprietorship ____ Partnership ____ Corporation Other: ______
Principals Names & Titles (include names of Partners):______Trade References
Company : ______Contact: ______Phone: ______Fax: ______
Address: ______
Company : ______Contact: ______Phone: ______Fax: ______
Address: ______
Company : ______Contact: ______Phone: ______Fax: ______
Address: ______
Company : ______Contact: ______Phone: ______Fax: ______
Address: ______
Authorization to release Bank information:
Bank Name: ______Acct Contact: ______
Bank Address: ______
Acct #’s: ______Phone # : ______
Signatory Name (print) : ______Authorized Signature : ______
Title : ______Date : ______
Upon credit approval, the oversigned agrees to abide by payment terms as contracted.