Customer Application graphic

Account Information

Corporate Structure
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If you are tax-exempt complete the tax-exempt certificate and return by mail, fax, or email.


Please fill in the names and addresses of all principal Partners


Please fill in the name and address of the President and General Manager


If individually owned but not incorporated, please fill in the name of the individual owner


The undersigned, as an authorized agent for buyer, agrees the buyer shall pay all obligations together with attorney and/or collections fees incurred. If the buyer fails to comply with any of the terms and/or conditions and/or fails to satisfy any obligation of the buyer to the seller; or if the seller with reasonable cause deems the obligation uncollectible without professional and/or legal assistance.

Customer Credit Record

Please complete this form and submit your most recent financial statement (to Wholesome Foods, Inc., 986 South Ox Rd., Edinburg, VA 22824), which we shall hold in strict confidence.

Our standard credit terms are Net 7 Days from Invoice Date

Credit References


Supplier One

Supplier Two

Supplier Three

I hearby authorize Wholesome Foods to obtain all pertinet information regarding my credit records necessary in order to process this application. Failure to pay any debt to Wholesome Foods Inc. will result in a charge of 2% per month as well as court costs if needed and attorney fees.