New Account Application

Please fill out all applicable fields completely.

Your Email:

Salesman:

Corporate Name:

Name:

DBA/ Trade Name:

Address:

City:

State:

Zip:

Address 2:

City 2:

State 2:

Zip 2:

Phone Number (Area Code):

County:

Tax Exempt No.:

Type of Business:
Corporation
Proprietorship
Partnership

Officers/Partners Names and Residence Address (include social security number):

Length of Time in the Business:

Name other Businesses Owned:

Previous Employment if less than 2 years in business:

Have you purchased from SRA previously?
Yes
No

If yes, under what name?

List anticipated monthly purchases from SRA:

Banking References

Bank Name:

Account #:

Address:

City, State, Zip:

Bank Telephone:

Bank Officer Contact:

Trade References (Preferably Other Food Distributors)

Name:

Address:

City/State/Zip:

Phone:

Payment Terms with Vendor:

Name:

Address:

City/State/Zip:

Phone:

Payment Terms with Vendor:

Name:

Address:

City/State/Zip:

Phone:

Payment Terms with Vendor:

Name:

Address:

City/State/Zip:

Phone:

Payment Terms with Vendor:

Payment Terms Requested*:

*If payment terms requested are other than cash or COD, you must click here to download the Personal Guaranty, fill it out and mail it to:
P.O. Box 12084
Birmingham, AL 35202
We cannot complete your application until this form has been received in our office. Thank you.

For our credit department to finish your application please download, print, read and complete this form. Please send the completed form via fax to 205-323-1772 (attn: Credit Dept.) or mail it to P.O. Box 12084 Birmingham, AL 35202 (attn: Credit Dept.) Thank you, our Credit Department will be contact with you soon.