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Corporate Account Application Please Complete All Requested Information! Date : 23rd Feb, 2012 Company Name : Street Address : City : State : Zip : MAIN PHONE # OF COMPANY (This is the phone # under which account will be maintained. This # should be provided when placing any order to be charged to the account.) : NAME & TITLE OF PERSON TO WHOM WE SHOULD MAIL MONTHLY STATEMENTS : NAME & TITLE OF COMPANY OFFICER OPENING ACCOUNT : NAME(S) OF COMPANY EMPLOYEES ALLOWED TO CHARGE TO THIS ACCOUNT : CORPORATE CREDIT CARD (circle one): AMEX MC VISA DISCOVER Credit Card # : REQUIRED INFORMATION Expiration Date : Name on Card : CREDIT CARDS ARE CHARGED AT THE END OF EACH MONTH. A COPY OF THE MONTHLY ITEMIZED STATEMENT WILL BE MAILED TO YOU ALONG WITH THE CUSTOMER COPY OF THE CREDIT CARD RECEIPT. (NOTE: WHEN REQUESTED, PAYMENT BY CORPORATE CHECK UPON RECEIPT OF MONTHLY STATEMENT IS ACCEPTABLE. HOWEVER, CREDIT CARD INFORMATION MUST STILL BE PROVIDED ABOVE.) SIGNATURE OF COMPANY OFFICER OPENING ACCOUNT : (signature) (date) By typing your name in the space above, checking the "I Agree" box and clicking the "I Accept" button, you intend for the process to create a binding obligation subject to the General Terms of this Agreement/Application. You agree that upon acceptance by LONG ISLAND GOURMET (aka East 31st Food Corp.), your Agreement shall be considered a "writing" or "in writing" and shall be deemed for all purposes (i) to have been "signed" by you and (ii) to constitute an "original" when printed from electronic files or records established and maintained in the course of normal business. You agree that a printed version of this Agreement and of any notice given in electronic form shall be admissible in any judicial or administrative proceedings based upon or relating to this Agreement to the same extent and subject to the same conditions as other business documments and records originally generated and maintained in printed form. I Agree with the General Terms of this Agreement/Application.
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31 East Jericho Tpke. | Mineola | NY 11501 | Tel: (516) 248-2866 |   Info@longislandgourmet.net