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