HSF Acct/Credit Appl and Credit Card Auth

Account/Credit Application and Credit Card Authorization
The purpose of this form is to:
- collect information to assist us in determining the eligibility of your business to apply for an account with Heart Smart Foods;
- obtain authorization to use your credit card information for future orders, or until credit history is established and credit is approved.
Please complete all sections of this form as thoroughly as possible. Use the BACK and NEXT buttons to switch pages.

(*Note: As you work, you can click the SAVE AND CONTINUE LATER button to save the form before submitting in order to complete it later. A saved form that is partially filled can be opened online later with your previous work intact and you can continue filling it out. Completed forms can be printed for your own records. Instructions and options for saving incomplete forms and electronic signatures can be found on the HSF website)

CREDIT CARD AUTHORIZATION

Heart Smart Foods has approval to use the following credit card to pay for all orders from:
Business Name:
As on account application in part 1
Approval to use credit card is given as of:

MonthDayYear
Date
Credit card type:

VISAMastercard
Credit card number:
Expiry date:
Name on card:

First NameLast Name
Note: For the signature below, you have the option to type signature with your computer keyboard or draw signature on a touch-screen.
Signature of card holder: Signature*
Provide the names of people who are authorized to submit orders. Click the "ADD ANOTHER PERSON" button to submit additional names:

Terms & Conditions

Click to read Terms & Conditions
"The undersigned acknowledge that all merchandise remains the property of HEART SMART FOODS and is on consignment until such time as it is paid for in full by the business named above and/or personally by the undersigned. I/We agree to pay all bills upon receipt of invoice, or as otherwise expressly agreed. I/We agree to pay a service charge of 1.75% per month, 21% per annum ($5.00 per month minimum) on amounts owing after the due date (30 days from invoice). If payment is not received by the due date, I/we hereby authorize payment, including service charges, be charged to the authorized credit card on file. I/We hereby declare that all information provided herein is true, complete, and correct. I/We certify there are no judgments outstanding, nor are there any businesses in which I/We was/were a principal(s) that have declared bankruptcy in the last seven years. The undersigned will be personally responsible for legal costs or any other third party expense paid by HEART SMART FOODS for the recovery of any debt owing. The undersigned hereby waives entitlement under the personal Properties Security Act to receive a copy in writing of any financial statement or financial charge statement registered pursuant hereto. I/We also hereby authorize HEART SMART FOODS to obtain such credit reports or other information as may be deemed necessary in connection with the establishment and maintenance of credit. I/We acknowledge catalogue pricing is subject to change, monthly specials terms take precedence over the catalogue, and repacks are not guaranteed against damage. I/We also agree to the terms, conditions and policies stated in the catalogue."

All new accounts will be on a Prepay, Credit Card, or C.O.D. basis, and liable for related charges, until credit history is established and credit terms are approved.

Note: For the signature below, you have the option to type signature with your computer keyboard or draw signature on a touch-screen.
Signature of Applicant: Signature*
Your name* Today's Date: Date*
Should be Empty:

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Account/Credit Application and Credit Card Authorization

ACCOUNT/CREDIT APPLICATION

Banking Information

Shipping/Delivery Information

CREDIT CARD AUTHORIZATION

Terms & Conditions