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CUSTOMER INFORMATION SHEET

BUSINESS INFORMATION

Company Name:
Business Type: (Distributor/Retailer/Wholesaler/Individual/Other)
Years in Business:
Tax ID/Business Registration Number:
Website/Social Media

PRIMARY CONTACT

Full Name:
Position/Role:
Email:
Phone:

BILLING INFORMATION

Billing Address:
City/State/Zip Code:
Country
Accounts Payable Contact (If different):
Accounts Payable Email:

SHIPPING INFORMATION

Shipping Address (if different from billing):
City/State/Zip Code
Country:
Import License # (if required in your state/country)

BUSINESS PROFILE

Do you currently distribute/sell other snack or food products?
BUSINESS PROFILE
If yes, please list:
Approximate number of retails outlets/client you serve:
Which markets/region do you cover?
Expected monthly or quarterly order volume:

AGREEMENT

* I confirm that the above information is accurate and complete.
* Signature:
Signature
* Date: