CREDIT APPLICATION Remit by E-Mail To: julie@appalachianorchard.com	Remit by Snail Mail To: Appalachian Orchard Company P.O. Box 886 Martinsburg, WV 25402 Phone (304) 901-4388 Fax (304) 901-4342

DATE:	FEIN or Tax ID:
NAME OF BUSINESS:
PHYSICAL ADDRESS:	MAILING ADDRESS:
PHONE:	FAX:
TYPE OF BUSINESS:	Corporation	Partnership	Sole Proprietorship	Other
OWNER NAME:	OWNER PHONE:
ACCOUNTS PAYABLE CONTACT:	PHONE:	EMAIL:
WEBSITE:
BANK REFERENCE INFORMATION
NAME:	ACCOUNT NUMBER:
ADDRESS:
CONTACT:
PHONE:	EMAIL:

TRADE REFERENCE/CREDIT REFERENCE – REQUIRE 3
COMPANY NAME:
ADDRESS:
CONTACT:
PHONE:	EMAIL:

COMPANY NAME:
ADDRESS:
CONTACT:
PHONE:	EMAIL:

COMPANY NAME:
ADDRESS:
CONTACT:
PHONE:	EMAIL:

The Above information is for the purpose of obtaining credit and is warranted to be true. I/We hereby authorize AOC to investigate the references listed pertaining to My/Our credit and financial responsibility. Application is hereby made by the person or corporation (“Customer”) for an open account. Customer agrees to pay APPALACHIAN ORCHARD COMPANY for all purchases on a Net 30 Day basis. Customer agrees to pay all collection costs, plus reasonable Attorney’s fees and venue shall be Martinsburg, West Virginia.

Signed:	Title:
Print Name:	Date:

Applicants Signature attests financial responsibility, ability and willingness to pay our invoices in accordance with our terms.