Customer Account Information
Please fill out the following information to set up a customer account with Capay Valley Farm Shop.
Your Business Name
*
Buyer Contact Name
*
First Name
Last Name
Buyer Phone Number
*
Please enter a valid phone number.
Format: 000-000-0000.
Buyer Email Address
*
example@example.com
Any additional contacts that should receive our list and access to online storefront?
Name and Email addresses
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Receiving Contact Name
*
First Name
Last Name
Receiving Phone Number
*
Please enter a valid phone number.
Format: 000-000-0000.
Receiving Email Address
*
example@example.com
Delivery Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Receiving Days
*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Preferred Receiving Hours
*
Absolute Earliest and Latest we can arrive? Receiving Hours
*
Instructions for Delivery (where to park, which door to enter through, who to call if necessary)
*
Is a blind delivery / dark drop possible outside of your normal receiving hours? If so, please provide details on how we can make that happen.
*
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Billing Contact Name
*
First Name
Last Name
Billing Contact Email Address
*
example@example.com
Billing Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Payment Method (Net 15)
*
Online/Electronic (find us on bill.com)
Check
Credit Card: Your information will be kept securely on file and we will charge you on Wednesdays for any open invoices. We will follow up to take down your information.
How did you find out about Capay Valley Farm Shop?
*
Submit
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