Become a Customer

New Customer Application

New Customer Application (with Credit)

Complete the application below to establish a new customer account with Get Fresh Sales and apply for credit terms.

* indicates required fields

Step 1 of 3New Customer Application

Account Executive

Application Date

Legal Business Name*

Phone*

DBA

Fax

Street Address*

City*

State*

ZIP*

Billing Address is the same as Delivery Address

Business Type*

Incorporation State

Date*

Business incorporation/formation date

EIN / Federal ID#*

State Business License#*

Effective Date*

Business Category*

A/P Contact Name*

A/P Email*

Phone*

Ext.

Fax

Web Orders Email

Web Address

By checking this box, I require monthly electronic statements to be sent to the email address below.