Form

NEW BUSINESS CUSTOMER FORM

Minimum Order: $250
Delivery Day(s) based on your location
Business Terms: Net 15. Late payments: 1.5% monthly / 18% annually

Please provide the following information and we will be in touch to finalize your online account.

Business Name

Buyer's First Name*

Buyer's Last Name*

Buyer's Email*

Buyer's Phone Number*

Are there additional authorized buyers who will need an account?

Please indicate the name(s) and email address(es) of the additional buyers.

Preferred Method of Communication*

Please indicate how you would like us to communicate with you about your order and any updates.

Phone Call

Text

Will you accept substitutions in the event they are necessary?*

e.g., kale from a different farm than is initially chosen

Yes

I would prefer to be contacted to discuss possible options.

Delivery Street Address*

City*

State/Region*

Zip Code*

Please provide us with some information about delivering to your business:

Receiver's Name

Person responsible for receiving delivery.

Receiver's Phone Number

Number to call if there are any issues at delivery.

Receiving Hours*

The hours that we can deliver to you.

In the event an after-hours delivery is required, how would you prefer that we make the delivery?*

Please make the after-hours delivery. (Please provide instructions in the box below.)

No after-hours deliveries, please. Marty's Local should contact us to re-schedule delivery.

Are there any details we should know about delivering to your location?

e.g. how to deliver when business closed, door codes, where our drivers should leave deliveries, loading dock, etc.

Please provide us with the contact information for your Accounts Payable Department

Accounts Payable Contact *

Accounts Payable Phone*

Accounts Payable Email*

How Did You Hear About Us?*

Let us know how you found your way here!