Date:_________________

Company Name:___________________________________________
Address:_____________________________________________
City:_________________ State:____________ Zip:___________
Phone:___________________  Fax:_______________________
Type of Ownership:________________________________ Year Established_________

We would like to establish credit with your company.  
We authorize you to contact the following references:

Bank Information
Name of Bank:_______________________________________
Address:____________________________________________
City:_________________ State:______________ Zip:________
Account #:___________________________________________

We require a minimum of three trade references. Please note that Tree of Life, Burt’s Bees 
and NOW Foods do not disclose credit information. Please only list companies with whom you 
currently have terms, not accounts paid by credit card or COD. To facilitate this process,
please be sure include your account numbers and fax numbers for references listed.


Trade References

1.   Company Name:____________________________________
      Account number______________________________
      Address:____________________________________________________________
      City:____________________State:_______________ Zip:____________________
      Phone:____________________________ Fax:______________________________

2.   Company Name:____________________________________
      Account number______________________________
      Address:____________________________________________________________
      City:____________________State:_______________ Zip:____________________
      Phone:____________________________ Fax:______________________________

3.   Company Name:____________________________________
      Account number______________________________
      Address:____________________________________________________________
      City:____________________State:_______________ Zip:____________________
      Phone:____________________________ Fax:______________________________

4.   Company Name:____________________________________
      Account number______________________________
      Address:____________________________________________________________
      City:____________________State:_______________ Zip:____________________
      Phone:____________________________ Fax:______________________________

VERMONT CUSTOMERS: If applicable, a copy of Vermont Resale and Exempt Organization 
Certificate of Exemption should be returned with this application.

Authorized Signature:____________________________________________________

Title:_________________________________________________________________________