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ACCOUNT APPLICATION

AND PROFILE - CO

Please leave blank if you are contacting us for the first time.

Please enter the address where we can direct all deliveries.

Please Select a 4 Hour Delivery Window.

Example: Freight entrance on 101st. Ring bell.

PRIMARY CONTACT (BUYER)

PRINCIPAL/PARTNER CONTACT

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ACCOUNTS PAYABLE

BANK INFORMATION

Once submitted, Grapejuice Group will contact your business directly for bank and routing information.

TRADE REFERENCES

Please list two industry-related references

REFERENCE #1 *

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REFERENCE #2 *

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CONFIRMATION/SIGNATURE

Account applicant, hereafter known as the buyer, in consideration of obtaining purchases on credit from Grapejuice Group, herein after known as the seller, hereby agrees to the following: buyer agrees to honor all the terms and conditions of most current price list and invoices, and assumes all responsibility for attainment of said information. If this application is executed by a corporation, it includes and all successor in interest of said corporation and is binding on the same and all successors in interest, now and in the future. In the event of any delinquency of any account, buyer agrees to pay all collection costs, attorney fees and court costs in the collection of said account. Buyer consents to the venue and jurisdiction of any court located in Denver County, CO. Buyer agrees that in the event the buyer issues a check which does not clear the collection process, a $25.00 fee shall be added to the buyer’s indebtedness.

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