Garlic Valley Farms - Credit Application

Credit Application

Garlic Valley Farms, Inc. can only sell to commercial accounts and not to individuals*. If your business wishes to open an account (30 day terms available), please complete this credit application and press the "Submit" button at the bottom of this page. When your application is processed we will contact you by telephone.

*Want to buy a bottle or two? You can by clicking on one of the two logos below. They are just two of our on-line retailers.

For a bottle or two - Click here to order on line.

SOME OF OUR CUSTOMERS

Currently some 4,500 gourmet shops, specialty food stores and natural food, meat and fish markets carry our Garlic Juice.

Some are:
Whole Foods
Alfalfa's
Wild Oats
Sutton Place Gourmet
Omaha Steaks

Business Information

Company (or d.b.a.) Name:

Owner / Corporate Name:

Type of Ownership: Address Type:

Address 1:

Address 2:

City: State: Zip:

Telephone Number: Fax number:

Type of Business:

Years in Business: Federal Tax I.D:

Banking Information

Bank Name #1: Account Number:

Bank Address: Account Type:

Phone number: Contact Name:

Bank Name #2: Account Number:

Bank Address: Account Type:

Phone number: Contact Name:

Trade References

Reference #1: Account Number:

Phone number: Fax Number:

Reference #2: Account Number:

Phone number: Fax Number:

Reference #3: Account Number:

Phone number: Fax Number:

Personal Information (If Sole Proprietorship)

Name: Title:

Address 1:

Address 2:

City: State: Zip:

Social Security Number:

Phone Number: Email:

Additional Information

Name of individual(s) allowed to make purchases:

Do you always issue purchase orders with purchases?

How did you hear about Garlic Valley Farms?