CUSTOMER
Acct Number: ____________ PROFILE
Name of Firm: HARVEST COMPANY LTD
Billing Address:
12055 Coverment Center Parkway, Suite 425 Fairfax
(Telephone #)
Shipping Address:
(Fax #)
Buyers E-Mail Address: Chelseamarie7@gmail.com Web Page:
Type of Business: Corporation: Partnership: Sole Owner:
Date Incorporated: 6 Aug, 2020 State: London Fed Tax ID #: HRA45827
No. of Office Workers: Incorporated by 3 Number of Years in Business: 3years
Names of Owners, Partners, or Officers: HARVEST COMPANY LTD
If Branch, location of home office: ———- Where are bills paid?: Chase bank
Who is the person to contact regarding Accounts Payables: Graham (anttorny)
A/P Contact Persons E-Mail Address: Marhankajason@gmail.com
Name(s) of persons authorized to charge: HARVEST COMPANY LTD direct account (Chasebank
TAX EXEMPT? Yes No REQUIRE A PURCHASE ORDER? Yes No
If yes, please attach Tax Certificate. Listed with Dun & Bradstreet? Yes No
We expect out monthly purchases to be: $ Dun & Bradstreet Number:
Would your company like monthly statements? Yes No
Bank References: Personal charge accounts and credit cards are NOT acceptable References.
(Name) (Street & Address) (City/State/Zip) (Account #) (Telephone #)
(Name) (Street & Address) (City/State/Zip) (Account #) (Telephone #)
Trade references:
(Name) (Street & Address) (City/State/Zip) (Telephone #) (Fax #)
(Name) (Street & Address) (City/State/Zip) (Telephone #) (Fax #)
(Name) (Street & Address) (City/State/Zip) (Telephone #) (Fax #)
Our Credit terms are: "Due upon receipt of invoice". Accounts 30 days or more past due may be charged interest
at the rate of 1 1/2% per month or the maximum legally allowable rate in the purchasers state of residence.
Accounts 45 days or more past due may not receive shipments until account is current unless other arrangements
are made in writing with our Accounts Receivable Department. Accounts 90 days past due may be placed with a
collection agency and credit charges, court costs and reasonable attorney fees may be added to amount due
unless other arrangements are made with our Accounts Receivable Department.
This credit application is complete and accurate to the best of my knowledge. I have read, understood, and agree
to abide by the terms and conditions as stated in this document.
Signature of Authorized Agent: Chelsea Marie Chairman
Name Title
Yes I would like to receive promotions, announcements, invitations, and special offers from Reliant.
Please fax completed application back with signature to 713-425-5820.
Phone: (713) 425-5819 Customer Profile Revised: 09/03/16
