Government Application

Government Account Application - Set text to medium before printing: Menu: View/Text Size/Medium
If you have a standard form for opening accounts please fax it.
Confirmation Number: ________________________
Natural Foods Inc. DBA: BulkFoods.Com 3040 Hill Avenue, Toledo, OH 43607-2931
Phone: (419) 537-1713 Fax: 1 (888) 285-5266 Fax: 1 (419) 531-6887 CAGE code: 37HU2

_______________________________________________ , __________________________________ , ___________________________
Name/s ( Billing Address: ___________________________________ City _______________________ State ________ Zip _________

E-mail: ______________________________________ Retail Tax Number (Vendors License): N/A ___________________________

Phone: ( _________ ) ________________________ Fax: ( ________ ) _______________________ Year Established___________

Federal Non Profit Tax ID # _______________________________________ Website __________________________________________

Government Type US ______State _______ County___________ City ________________Other_______________
Ship To Location: (if different from billing address)

Address ________________________________ City ___________________ State ___ Zip __________

Phone: ( _______ ) _____________________ Fax: ( ______ ) ___________________
List officials / current responsible parties:

Name _____________________________________ Title ______________ Phone ( _________ ) ___________________

Address _____________________________________ City __________________________ State ______ Zip _______________

Name ________________________________________ Title ____________ Phone ( _________ ) _____________________

Address ________________________________________ City ___________________________ State ______ Zip ______________

Bank Name _________________________________ Acct No. ________________________________ Phone ( ________ ) ___________________

________________________________________________________________________________________________
Name Street Address City State Zip
References (Firms you purchase from on open account.)

Phone: ( __________ )___________________________ Fax: ( _________ )__________________________

_________________________________________________________________________________________________________
Name Street Address City State Zip Zip

Phone: ( __________ )___________________________ Fax: ( _________ )_________________________

GOVERNMENT GUARANTEE: This entity agrees to to Bulkfoods.com/terms.htm/terms.asp terms and conditions and to pay for goods purchased..

_________________________________________________________________________________________________________________________________
Printed Name ----------------------------------------------------------------- Signature ------------------------------------------------------ Title ----------------- Date mm/dd/yy

Invoices paid in ____30 days ____ 10 Days ____ Days. Number of locations? US ______Overseas ______
Type entity? Military: ___ Army ___ Navy ___ Air Force ___ Marines ____ Other: ________________
School: ___ University ___ College ___ High School ___ Grade School ___ Other: ________________
Prison: ___ Federal Prison ___ State Prison ____ County Jail ___ Municipal ___ Other: ____________

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Comments __________________________________________________________________________

______________________________________________________________________________________

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Estimated monthly purchase volume:__________ dollars OR ____________ pounds
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