Sales Application

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Sales Application

Please upload all required documents
Sales Rep
Terms Seeking
Name Registered with State
Doing Business as name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Is Business Address and Mailing Address Different?
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
Website
Tax Exempt Number *if tax exempt, include copy of certificate.
Tax ID/Fed ID
Year Established
Type of Business
Own or Rent Place of Business

Principals
Owner’s Legal Name

First NameLast Name
Social Security #
State:
Owner’s Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Home Telephone #
Please enter a valid phone number.Format: (000) 000-0000.
Cell Telephone #
Please enter a valid phone number.Format: (000) 000-0000.
Email:
Additional Principals
Additional Principals Legal Name

First NameLast Name
Additional Principals Social Security #
Additional Principals State:
Additional Principals Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Additional Principals Home Telephone #
Please enter a valid phone number.Format: (000) 000-0000.
Additional Principals Cell Telephone #
Please enter a valid phone number.Format: (000) 000-0000.
Additional Principals Email:

Order Contact (Include cell and home #'s):
Receiving Person (Include cell and home #'s):
Open Time:
Close Time:
Requested Time:
Special Delivery Requirement (Ex. Back door, front door, alley):
Other Delivery Request (Ex. Paper downstairs, Stack Flour on dunnage rack):
Earliest Delivery Time
Latest Delivery Time

Supporting Documents
Driver's License

Cancelof
Voided Check Or Digital Copy of Bank Account

Cancelof
Menu

Cancelof
*if tax exempt, Attached copy of certificate.

Cancelof
Any special requests?

Statement of Terms and Agreement

The undersigned ("Purchaser") agrees that all purchases made by the "Purchaser" from Colony Foods, Inc. (Seller) are subject
to the following terms and conditions:

A. I (we) authorize you to whom this application is made or your agents, to investigate my/our financial responsibility and
credit worthiness. I (we) agree and understand that personal credit reports may be drawn to aid in the evaluation
process, as deemed necessary.

B. All amounts due Seller is payable in accordance with the payment terms granted by Seller's Credit Department. If any
amount due Seller is not paid in accordance with such payment terms, a penalty charge may be added to the sum due.

C. Purchaser may pay Seller a service fee for all checks returned by Purchaser's bank.

D. Seller has the right to charge additional convenience fees for credit and debit payments.

E. At the sole option of Seller, a fuel surcharge may be imposed at any time for any delivery in an amount determined by
the Seller. This amount and assessment may be modified from time to time at the option of Seller. Purchaser agrees
to pay for said fuel surcharge upon being billed for same

F. Purchaser shall notify Seller by certified mail of any change in ownership.

G. In the event the account is turned over to an attorney or other collection agency for collection, or suit is brought on
same, or the same is collected via any judicial proceedings whatsoever, Purchaser agrees to pay all reasonable fees,
attorney fees, collection fees, interest at the rate of 1 ½ % per month on all unpaid invoice amounts, and court costs
incurred by Seller.

H. Colony Foods salespersons are expressly NOT authorized to approve or agree to any payment arrangements with
purchaser. All arrangements or settlements for payment must be approved by authorized accounts receivable
personnel of Seller.

I. Should the Purchaser order or request any custom made product or Special Order Item from the Seller, then all such
items or products specifically made for or ordered by the Purchaser shall be the responsibility of the Purchaser whether
or not said items are accepted by or delivered to Purchaser. A “Special Order Item” is defined as any good which is not
in the Seller’s stock of goods in the ordinary course of business and specially ordered for the Purchaser.

J. From time to time vendors and manufacturers offer direct rebates. To its best extent Seller and its employees will
handle accordingly and execute on purchaser’s behalf to take advantage of the rebate offer when applicable.
Printed Name

First NameLast Name
By (Authorized Signature)
Date

MonthDayYear
Date
Witness

First NameLast Name
Personal Guaranty

In consideration of the Seller's agreement to provide supplies to my business on such credit or cash terms as you may extend from time to time, I (we) do hereby guarantee individually and jointly, personally, and unconditionally the payment by said business of any amount due to Colony Foods from said business (including dishonored checks). In the event the account is turned over to an attorney or other collection agency for collection, or suit is brought on same, or the same is collected via any judicial proceedings whatsoever, purchaser agrees to pay all reasonable fees, attorney fees, collection fees, interest at the rate of 1 1/2 % per month on all unpaid invoice amounts, and court costs incurred by seller. By signing this Sales Application, the Purchaser agrees that Colony Foods, Inc. may obtain a credit report from the personal guarantor and any other signatories to
this agreement.
Printed Name

First NameLast Name
By (Authorized Signature)
Date

MonthDayYear
Date

Authorization Agreement for Visa, Mastercard, Discover, or American Express
I (we) hereby authorize, Colony Foods, Inc. to debit entries to my card account number below, hereinafter as automatically necessary to satisfy credit terms or as needed. The authority is to remain in full force and effect until Colony Foods, Inc. has received written notification from me (or either of us) of its termination in such time and manner as to offer Company and Financial Institution a reasonable opportunity to act on it. All payments will include a convenience fee of 3%.
Company Name
Name on the Card
Email
example@example.com
Card Information

Card NumberExpiration DateCVV #
Billing Zip Code
Signature
Date

MonthDayYear
Date

Authorization Agreement for ACH/EFT
Company Name
I (we) hereby authorize, Colony Foods, Inc. to debit entries to my (our) account indicated below and the financial institution names below, to debit the same to such account.
Bank information

Bank NameBranch
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Routing NumberAccount Number
Type of Account
Name

First NameLast Name
Signature
Date

MonthDayYear
Date

Form ST-12EC

Exempt Container Certificate
Seller's Name (Registered Vendor)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I hereby certify that the packaging described may qualify as exempt containers used to transport food off premises pursuant to Massachusetts General Laws (MGL), Ch. 64H, sec. 6(q). See Massachusetts Regulation 830 CMR 64H.6.5(8).

Description of property Delivery bags, cups & lids, soup containers or bowl & lids, salad containers or bowls & lids, pizza boxes and corresponding box
packaging inserts, sub and sandwich containers and wraps, foil, paper or styrofoam containers & lids.

Full liability is hereby assumed for the payment of any use tax due in the event that the packaging purchased is used for other than exempt purposes
specified above. This certificate shall be considered a part of each order unless revoked in writing. All vendor orders under this certificate will clearly indicate that they represent packaging that may qualify as exempt container purchases
Signature (Signed under the Penalties of perjury)
Name of Company
Title
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date

MonthDayYear
Date
General Information
his form is to be completed by a purchaser (registered vendor MGL Ch. 64H, sec. 7) and given to and retained by the seller. The seller must make sure that the certificate is completed properly and signed before accepting it. For information regarding the requirements for retaining records, see Massachusetts Regulation 830 CMR 62C.25.1.

Sales of containers to purchasers who are registered vendors are not taxable, subject to the proper use of Form ST-12EC, Exempt Container Certificates.

The term container is limited to items used in transporting food or drink off the premises. The meaning of the term is found by determining the use to which a particular item is put. When a paper or plastic product is used to transport food off the premises, it is a container. The term container may include, for example, paper or plastic wrappers, cups, cup lids, or multicup holders used to carry more than one drink, if these items are used to transport food or drink off the premises. The same items used on premises are not considered to be containers for purposes of the exemption. Coffee stirrers, napkins and straws are examples of items not considered containers whether used on or off premises.

If, upon the purchase of packaging, the purchaser is unable to determine whether the packaging will qualify as exempt containers, the purchaser may give the seller a Form ST-12EC, Exempt Container Certificate. The certificate may be given and accepted only for those items that may be exempt containers depending on later use. Acceptance of a fully and properly completed certificate will relieve the seller from further liability for the tax. The purchaser must keep an accurate record of the containers used to transport food or drink off premises. Packaging not so used is subject to tax and must be reported on the purchaser’s Form ST-9, Sales and Use Tax Return, or its Form ST-10, Business Use Tax Return, as applicable.

Warning: Willful misuse of this certificate is subject to criminal tax evasion penalties of up to one year in prison and $10,000 ($50,000 for corporations) in fines.

If you have any questions about the acceptance or use of this certificate, please contact:
Massachusetts Department of Revenue
Customer Service Bureau
PO Box 7010
Boston, MA 02204
(617) 887-MDOR
Should be Empty:

Principals

Supporting Documents

Authorization Agreement for Visa, Mastercard, Discover, or American Express

Authorization Agreement for ACH/EFT

Form ST-12EC