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COVID-19 Information
About Us
Contact Us
Become a Customer
Customer Application
Partnerships
Marketing Partner Information Update
Responsibility
Food Safety
Safety Data Sheets
Sustainability
Service Area
Solutions
Crispy Chick & Fish
Ideas and Innovations
National and Program Accounts
Nutrition Services
Receiving Appointments
Customer Application
1
Name and Email
2
Billing
3
Shipping
4
Customer Details
5
Owners
6
Banking & Accounts Payable
7
References
8
Sign and Complete
Thank you for your interest in becoming a customer of Merchants Foodservice.
Before getting started, please provide your full name and a valid email address.
Full Name
*
Email Address
*
Sales Rep Name/Number
Please enter the Name and/or DSR number of your Merchants Sales Rep, if you know it.
In the following form, please provide your Billing information.
Corporate Name
*
Attention
*
Billing Address
*
Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
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Louisiana
Maine
Maryland
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Michigan
Minnesota
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Nevada
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New Mexico
New York
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Ohio
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Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
County or Parrish
*
Inside City Limits?
*
Yes
No
Phone No.
*
Email Address
*
In the following form, please provide your Shipping information.
d.b.a. Trade Name
*
Shipping Address
*
Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
County or Parrish
*
Inside City Limits?
*
Yes
No
Inside Corporate Limits?
*
Yes
No
Inside Police Jurisdiction?
*
Yes
No
Phone No.
*
Email Address
*
DUNS
In the following form, please provide more details about your company.
Choose Customer Type
*
Select Type
Bar & Grill
Barbeque
Camps
Catering
Burger Restaurant
Chicken Restaurant
Church or Synagogue
Colleges & University
Convenience Store
Country Club
County & City Jail
Daycare
Deli
Family Style & Buffet
Fast Food
Gaming & Casino
Head Start
Home Health
Hospital
Hotel & Motel
Inplant Feeding
Independent Distributor
Mexican Style Food
Military
Nursing Home
Oriental Style Food
Pizza or Italian Style Food
Prisons
Private Business
Private Clubs
Recreational
Retail Grocery
Schools/Private/Contract
Schools/Public/Contract
Seafood/Fish Camps
State Parks
Summer Feeding
Truck Stops
Vending
White Table Cloth
Miscellaneous
U.S.D.A Commodities
Bakery
Produce - Sunrise Fresh
Group Home
Dropship
Multi Unit - Other
Multi Unit - Hamburger
Multi Unit - Chicken
Multi Unit - Military
Schools DSR
Samples
Misc. Contract
Relief Organizations
Steakhouse
Multi Unit - Ice Cream
Multi Unit Pizza/Italian
Nursing Home/Alliance Purchasing
Cafe/Drive In
Multi Unit - Sandwich
Multi Unit - Steak House
Ice Cream / Yogurt
Interbranch Transfers
USDA Farm to Families
C-Store Crispy Chick
Distributors - Broadline
ABM Test
Healthcare Multi-Unit
Multi Unit Focus Brands
Multi Unit - Hotel
Butcher/Meat-Shop
Greek/Mediterranean
Multi Unit Cafeteria
Multi Unit Breakfast
Type of Ownership
*
Proprietorship
Partnership
Corporation
LLC/LLP
Franchise Of
New Owner?
Yes
No
Purchase Date
Month
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Day
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1927
1926
1925
1924
1923
1922
1921
1920
No. Years in Business
*
Add all of the owners of your company. Use the 'Add Another Owner' button to add more.
Owner #1
Full Name
*
% Owned
*
Home Phone No.
*
Title (if Corp.)
Social Security No.
Rent or Buy?
Rent
Buy
Home Address
*
Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Date of Birth
*
Month
1
2
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12
Day
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1922
1921
1920
Drivers License No.
*
Driver's License
*
Accepted file types: jpg, tga, png, gif, pdf, tif.
Upload a copy of your Driver's License here
Add Another Owner?
*
YES
NO
Owner #2
Full Name
*
% Owned
*
Home Phone No.
*
Title (if Corp.)
Social Security No.
Rent or Buy?
Rent
Buy
Home Address
*
Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Date of Birth
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
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Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
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1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Drivers License No.
*
Driver's License
*
Accepted file types: jpg, tga, png, gif, pdf, tif.
Upload a copy of your Driver's License here
Provide both accounts payable and banking information here.
Accounts Payable Contact
*
Phone No.
*
Anticipated Weekly Purchases
*
Federal Tax ID
*
State Tax ID
*
Sales Tax Certificate
*
Accepted file types: jpg, tga, png, gif, pdf, tif.
Upload a copy of your Sales Tax Certificate here
Name of Bank
*
Bank Contact
Bank Address
*
Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Bank Account No.
*
Bank Phone No.
*
Terms Requested
*
Auto Draft
Collect on Delivery (COD)
Net 2 Days
Net 7 Days
Net 14 Days
Net 21 Days
Net 30 Days
ACH Debit Authorization
The purpose of this form is to authorize electronic debit transactions.
I authorize the payment of (choose one):
*
AR Invoices
Dues
Bills
Payment Frequency
9 Digit Routing Transit Number
*
Please attach a copy of a voided check
*
Accepted file types: jpg, gif, jpeg, png, tga.
Consent
*
I agree to the below payment policy.
I hereby authorize Merchants FoodService to initiate a charge (debit) entry at the Financial Institution indicated above, and initiate adjustments (if necessary) for any transactions debited in error. I agree that each payment shall be the same as if it were an instrument personally signed by me. This authority is to remain in effect until revoked by me in writing.
I understand, that both the Financial Institution and Merchants FoodService reserve the right to terminate this payment plan.
Add any trade references here, preferably food distributors. Use the 'Add Another Reference' button to add more.
Reference Name
*
Phone No.
*
Address
*
Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Terms of Sale/Payment Terms
*
Add Another Reference?
*
YES
NO
Section Break
Reference Name
*
Phone No.
*
Address
*
Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Terms of Sale/Payment Terms
*
Read the terms and conditions agreement before signing and submitting the form.
Please review the application for accuracy before continuing to the next step. After clicking the Sign & Complete button, you will not be able to modify the contents of the application. To verify accuracy you may navigate through the form using the navigation buttons or by clicking the section headings.
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