Atlas Wholesale Customer Registration Form

Atlas Wholesale Food New Customer Application & Agreement

Please fill out this application form to become an Atlas customer. If you are requesting payment with terms, you will be asked to fill-out the credit application.

Your application will be reviewed by the Atlas team and you will be informed when an account has been created for you.
Customer Details:
Business Name*

Name of Business (DBA)Corporation Name and / or Legal Enttiy
Legal Entity Type:*

CorporationPartnershipProprietorshipLLC
Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is Billing Address the same as Shipping Address?

YesNo
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Purchasing Contact Person*

First NameLast Name
Store Phone Number*
Cell Phone Number*
Purchasing Contact E-mail*
example@example.com - this is where delivery confirmations will be sent
Billing Contact Person*

First NameLast Name
Billing Contact E-mail*
example@example.com - this is where billing statements will be sent
Special instructions
ACCOUNT INFORMATION

Let us get to know your needs!
Estimated weekly delivery amount (in dollars):*
Must be numeric
Earliest time accepting deliveries
Latest time accepting deliveries
Days and hours of operation
Terms Requested
All customers are credit on delivery (COD) for the first deliveries, but as we build our relationship we would love to be able to accommodate increased credit terms. If you would like credit terms, you will be required to complete a credit application.
Who is your current distributor?*

CREDIT APPLICATION
Because you have requested COD, there is no credit application to complete at this time. Please select [Next] to agree to terms and conditions.
Business Tax ID / EIN*
Owner Name*

First NameLast Name
Owner Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owner Date of Birth*

MonthDayYear
Date
Owner Social Security Number*
Owner Drivers License Number*
Trade References - At least 3 are required
Individual / Joint Personal Guarantee

In order to induce Atlas Wholesale Food Company to extend and open credit to the above listed company, of which I have direct financial interest and / or for which I am an officer or agent, I do hereby guarantee payment to Atlas Wholesale Food Company of all indebtedness of any sum due from the company if it fails to pay upon demand. I do hereby waive notice of default, non-payment and notice thereof and consent to any modification or renewal of the credit agreement. If any balance is turned over to a collection agency or an attorney for collection, I (we) agree to pay actual reasonable attorney fees, normally estimated to be 40% of the balance due, which is standard in the industry, plus all other collection costs.
Guarantor #1 Name*

First NameLast Name
Guarantor #1 Signature*

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Guarantor #2 Name

First NameLast Name
Guarantor #2 Signature

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Terms & Conditions
For the purpose of obtaining an account with Atlas Wholesale Food, I (we) state the above Information is true and correct. The parties hereby agree that all purchases are subject to the following terms and conditions: COD payments are to be provided to the driver upon delivery. ACH payments will be pulled by Atlas from Customer per the agreed terms. All other payments with terms are to be sent to: Atlas Wholesale Food Co, 35500 Central City Parkway, Westland MI 48185, in accordance with the Credit Terms that are granted. I(We) agree to pay 1.5% per month, annual percentage rate of 18%, Time – Price Differential Charge on my amount past due. I (We) understand that Credit Cards will be billed 3% processing fee, plus $50 per failed Credit Card transaction. I (We) understand returned checks and failed ACH payments will result in a $100.00 assessment which must be paid immediately. Atlas Wholesale Food shall have the right to demand payment of the return check(s) or failed ACH in CASH or CERTIFIED funds or MONEY ORDER within forty-eight (48) hours. Atlas reserves the right to hold deliveries for any customer who has past due amounts. It is further agreed that the undersigned will pay all collection agency fees and reasonable attorney fees that may become necessary to effect collection of this account. All new accounts will be shipped C.O.D. until credit is approved by the credit office. Customer’s credit worthiness and terms are subject to change at any time at Atlas’s sole discretion. The parties hereto agree and consent to venue in Wayne County, 36th Judicial District Court in Detroit, Michigan for any lawsuit to be filed to enforce the obligation in this agreement.
Atlas Customer Return Policy
Signing this box confirms that you have the authority to submit this application on behalf of the company and that you have read and agree with the Terms and Conditions as listed in this form.*

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Approver Name*

First NameLast Name
Approver's Email*
example@example.com
Business Type - Please select one:*
Upload a copy of the Owner's Driver's L

Cancelof
Should be Empty:

Customer Details:

ACCOUNT INFORMATION

CREDIT APPLICATION

Because you have requested COD, there is no credit application to complete at this time. Please select [Next] to agree to terms and conditions.

Individual / Joint Personal Guarantee

Terms & Conditions