Marque's Food COD Application
We DO NOT deliver outside of Southeast Louisiana, so please do not fill out this application if you are not in one of the following areas: New Orleans, Metairie/Kenner, Houma, Baton Rouge, Hammond, Northshore, Slidell, Westbank, Chalmette, and surrounding areas. If you have further questions, please reach out to customerservice@marquesfood.com.
Full Legal Business Name
*
D/B/A
Delivery Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State/Province
Zip Code
Billing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Provide a 4 Hour Delivery Window
*
Tax ID Number
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
How long has this business been at this address?
*
Which of these correctly categorizes your business?
*
Proprietorship
General Partnership
Ltd. Partnership
Corporation
LLC
If Corporation, what are the date and state of corporation?
If you are working with a Marque's Food salesman, who is it?
Contact Person(s)
Please fill out the first one and the second, if applicable.
Name
*
First Name
Last Name
Driver's License Number
*
Title
Phone Number
*
Please enter a valid phone number.
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name
First Name
Last Name
Driver's License Number
Title
Phone Number
Please enter a valid phone number.
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Signature
*
I acknowledge that my account is strictly COD (Cash on Delivery) and in the event that cash or check is not available to pay for my order at the time of delivery, that my merchandise will not be delivered. I also acknowledge that by filling out the Credit Card/Debit Card option below, that I can insure that my delivery is made should cash or check not be available at delivery.
Payment Method
If you would like to pay credit/debit card, please reach out to your salesperson or our sales manager, Leo Schaeffer at leo@marquesfood.com.
I hereby authorize Marque's Food Distributors to charge my account using 1 of the following 3 methods.
*
Cash/Check Purchases
Credit/Debit Card Purchases
Automatic Deposit (ACH) Purchases
If you chose the Automatic Deposit (ACH) option, please fill out the following information.
Name
First Name
Last Name
Company Name
Bank
Bank Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Routing Number
Account Number
Signature
Please upload your LDR (Louisiana Dept. of Revenue Sales Tax Exemption Form) and your City Tax Exempt Certificate (if applicable).
Browse Files
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Choose a file
If these forms are not submitted, your account will be charged until certificates are provided. Sales tax cannot be refunded.
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