Credit Application

Please complete entire form. Missing information will delay application approval.

DBA
Salesperson
Legal Entity
Date
MM slash DD slash YYYY
Street Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Terms Applying for:
- Net 7
- Net 14
- Net 30
- C.O.D.
Federal ID#
Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Building Owned or Leased?
Kind of business:
Years in business:
Have you done business with UVP before?
If yes under what name?
Names of Officers/Owners
Officer/Owner 1 Name
Home Phone
Officer/Owner 1 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Electronic Signature of Officer/Owner 1

First and last name
Date Signed

Example format: 00/00/0000
Officer/Owner 2 Name
Home Phone
Officer/Owner 2 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Electronic Signature of Officer/Owner 2

First and last name
Date Signed

Example format: 00/00/0000
Legal Entity Name
Years Established:
Bank Affiliation:
Account Number
Business References: Acct. Number, Telephone

(No Bank or Utilities - Suppliers Only)
Reference 1 Name
Reference 1 Account Number
Reference 1 Phone
Reference 2 Name
Reference 2 Account Number
Reference 2 Phone
Reference 3 Name
Reference 3 Account Number
Reference 3 Phone
To secure the payment of Applicant’s obligations to Upper Valley Produce “UVP”, applicant and guarantor hereby grant UVP a security interest in any of the following property related to the business which applicant may own, plus (a) all property of the same classes which may be acquired by the applicant or guarantor subsequent to the execution of this application. (b) all proceeds thereof: and (c) all increases, substitutions, replacements and additions thereto. The property subject to this provisions all inventory, equipment, machinery, furniture, fixtures, accounts, accounts receivable, contracts and contracts rights. UVP is authorized to file a UCC financing Statement to confirm this security interest.

Credit Application

Names of Officers/Owners

Business References: Acct. Number, Telephone

CONTACT

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