New Account Information

    Salesman # ( For Office Use Only )
    Date:
    Assigned Account # ( For Office Use Only )
    Ship to Name:
    Street Address:
    City:
    County:
    State:
    Zip Code:
    Phone number:
    Fax number:
    Hours of Operation:
    Delivery Instructions:
    Online ordering:
    Enter email address:
    Invoices via email:
    Enter email address:
    Statements via email:
    Enter email address:
    Bill to Name:
    Website:
    Bill to address:
    A/P Contact:
    A/P phone #:
    Cigarette License (DLN)#:
    Liquor License Number #:
    State Tax License #:
    Other Tobacco Products License (If applicable):


    FOR OFFICE USE ONLY
    FOR OFFICE USE ONLY
    Must be completed by salesman before number can be issued:
    Assigned delivery day: _________________
    Truck: _________________
    AWI __
    Misc. ______________
    Store type: ______________
    Recommended Terms: _______
    Pricing Schedule: ______
    APPROVAL: ______________
    Anticipated Weekly volume $ ______________________
    Anticipated Weekly Carton volume # ______________________




    Do you want to apply for credit?
    Business/Trade Name of Customer ("Customer"):
    Address:
    City:
    State:
    Zip:
    Phone number:
    Fax number:
    Amount of Credit Requested: $

    Form of Organization of Customer (Check One):


    Sole Proprietor:
    Owner Name:
    Social Security Number:
    Residence Address:


    Date Formed
    Federal Taxpayer Identification Number:


    Date Formed
    Federal Taxpayer Identification Number:


    Date Formed
    State:
    Federal Taxpayer Identification Number:
    President:
    Secretary:
    Treasurer:
    Address:



    On what date did the customer commence doing business?
    Does the customer own or rent the premises?
    Has the customer or any of its principals ever been involved in other business(s)?
    Has the customer or any of its principals been involved in a bankruptcy or insolvency proceeding in the past seven (7) years?

    Bank

    Name of Bank:
    Phone No:
    Address of Bank:

    Trade References

    Business Name:
    Address:
    Name of Contact:
    Telephone:
    Fax:

    Business Name:
    Address:
    Name of Contact:
    Telephone:
    Fax:

    Business Name:
    Address:
    Name of Contact:
    Telephone:
    Fax:

    I/WE FURNISH THE ABOVE INFORMATION AND CERTIFY ITS CORRECTNESS FOR PURPOSES OF DOING BUSINESS ON OPEN ACCOUNT, AND I/WE HEREBY AUTHORIZE L.J. ZUCCA, INC. TO OBTAIN SUCH INFORMATION IT MAY REQUIRE CONCERNING THE STATEMENTS MADE IN THIS APPLICATION. I/WE ALSO AGREE THE INFORMATION MAY BE GIVEN TO A CREDIT BUREAU.


    Title:
    Print Name:
    Date:

    TERMS OF SALE

    7 DAYS NET IF CREDIT IS ACCEPTED; IMPORTANT: FINANCE CHARGE is computed at the rate of 1.50% per month on all balances 30 days past due which is an ANNUAL PERCENTAGE RATE of 18%. FINANCE CHARGES are applied to the previous balance after deducting current payments and/or credits. All invoices referred for collection will be subject to costs of collection and reasonable attorneys= fees. The Customer irrevocably submits to the jurisdiction of the New Jersey Superior Court in the event L.J. Zucca, Inc. decides to institute suit to recover the balance due from the Customer.


    Date
    Print Name/Title:

    GUARANTEE

    For and in consideration of L.J. ZUCCA, INC. extending credit to (Company Name)
    from time to time,
    and

    (the “Guarantors”), the undersigned jointly and severally GUARANTEE payment for all goods heretofore or hereafter sold by L.J. ZUCCA, INC. to said Customer, together with Finance Charges and, if referred for collection, collection costs and reasonable attorneys fees. This is an open and continuing guarantee and shall continue in force, without obtaining the consent of, and notwithstanding failure to notify, the undersigned of any change in the form of indebtedness, renewal or extension thereof. The undersigned, jointly and severally, hereby expressly waive notice of indebtedness, default, presentment, demand, protest and notice of protect on any and all forms of such indebtedness. The Guarantors irrevocably submits to the jurisdiction of the New Jersey Superior Court in the event L.J.Zucca, Inc. decides to institute suit to recover the balance due from the Guarantors. I/We authorize a credit investigation by L.J. ZUCCA, INC. or its representatives.

    SIGNATURE
    Print Name:
    Social Security Number:
    Date Signed:
    SIGNATURE
    Print Name:
    Social Security Number:
    Date Signed:

    Do you want to apply for ACH?

    ACH Authorization

    I hereby authorize L. J. ZUCCA, INC. to initiate charges to my (our) checking/savings/credit/debit accounts at the financial institution listed below (THE FINANCIAL INSTITUTION) and using the CCV information provided. And, if necessary, initiate adjustments for any transactions credited/debited in error.

    This authority will remain in effect until L. J. ZUCCA, INC. is notified by me (us) in writing to cancel it in such time as to afford L. J. ZUCCA, INC. and THE FINANCIAL INSTITUTION a reasonable opportunity to act on it.


    *Please Note: ACH method will be selected as default payment method unless a request is made indicating another preference*

    (Name of Financial Institution)
    (Address of Financial Institution - Branch, City, State, & Zip)
    (Name on Account)
    Date
    Select Type of Account
    Routing Number
    Bank Account Number:
    These numbers are located on the bottom of your check as follows:
    Please attach a voided check