HILLCREST FOODS, INC.
104 Huntville Rd., Fairfax, Vt. 05454
1-800-287-6586 or 802-849-6586
FAX # 802-849-6101

Prospective Account Information Sheet
(PLEASE PRINT LEGIBLY)

Billing Address:

Company Name: ___________________________________________________

DBA: ____________________________________________________________

Address: __________________________City: ___________________________

State: _______ Zip Code: ________ Phone: _____________ Fax: ____________

E-mail address: ____________________________________________________

Shipping Address: (if different)

Address: ___________________________ City: __________________________

State: _______ Zip Code: ________ Phone: _____________ Fax: ____________

Owner or Sr. Officer ________________ S.S. # _______________ Phone: ___________

Accounts Payable Contact Name: ___________________________ Phone: ___________

Buyer’s Name: ________________________ Hours of Operation: __________________

Incorporated: Yes ______ No ______ Number of Years in Business_______________

Dun # _________________________________ FED I.D. # _______________________

Name of Bank: ___________________________________________________________

Address: _____________________ City: ________________ State: ____ Zip: _________

Phone: ________________ Fax: _____________ Person to Contact: ________________

Type of Acct: Checking # ____________________ Savings # ______________________

Other Accounts: __________________________________________________________

Current Suppliers

1. Name: ___________________ Phone: ________________ Fax: ______________

Address: _____________________________ How long doing business: ________

2. Name: ___________________ Phone: ________________ Fax: ______________

Address: _____________________________ How long doing business: ________

3. Name: ___________________ Phone: ________________ Fax: ______________

Address: _____________________________ How long doing business: ________

4. Name: ___________________ Phone: ________________ Fax: ______________

Address: _____________________________ How long doing business: ________

Signature _____________________________ Title ______________________________

Personal Information Section

Home Address: _________________ City: _______________ State: ____ Zip: _______

Phone (for emergency use only) ___________________ Own ________ Rent: ________

Personal Bank: _______________________ CK # __________ SVS # ______________

Address: _______________________________ Person to Contact: _________________

Have you or your company ever declared bankruptcy and/or had a foreclosure action, attachment, judgment or liens filed against you? YES _____ NO _____ If yes, explain & give dates: 

This application will become valid only if completed and signed by an individual authorized to make purchase agreements and sign contracts, and has the authority to authorize the payment of billing statements. In consideration of extending credit to _______________________________ (Company Name) at my request, I hereby agree to personally guarantee payment on demand any sum for materials and supplies, sold and delivered, which may become due whenever the company shall fail to pay the same. It is further understood that I will be responsible for the ATTORNEY’S FEES AND COLLECTION COSTS according to law, if procedures are instituted. I herewith authorize the company listed above or its designated representative to conduct a Credit Search on my Credit Background.

Signature _________________________________

Date _____________________________________

Resale Certificate # _____________________________

(attach copy)

I authorize you to release financial information to Hillcrest Foods for a credit check on my accounts with your company. Thank you.

Signed _____________________________

Dated ______________________________

All customers must complete and sign a credit application and personal guarantee.

We would like all new customers to be COD for the first few deliveries so that we can establish their buying patterns. Once buying patterns are established, their (weekly, monthly, bi-weekly) credit terms can be discussed.

All returned checks are subject to a $25.00 service charge. Any account tendering a bad check will immediately be placed on COD basis and all future purchases will be cash or certified check.

Any accounts that fall behind their credit terms will be placed on COD along with an "on account" amount.

If any account is on COD and a check is not there when our drivers arrive, the drivers are instructed not to deliver the order unless prior arrangements have been made.

If a customer requires credit on a product, the product must be returned to the warehouse and a credit memo will be mailed to the customer. If the product being returned is a refrigerated or frozen product, we ask that it remain in its appropriate place until picked up.

Please be made aware these policies will be strictly enforced.

Effective 2/12/01: There is a $3.50 delivery surcharge in lieu of an across the board price increase.

_______________________________________
Signature / Date