Gourmet Coffee Roasters – Wholesale Catalog

I certify that I am at least 18 years of age and have the authority to apply for credit in thename of the above named business (“field business name”), and that I have read and agreed to all the terms, conditions and disclosures indicated on this page, and that I have accurately and fully completed all items on this application. I understand that this offer to establisha credit account was initiated by Fortunes Food & Coffee Co., Inc. (“Fortunes”) on behalf of Fortunes Food & Coffee Co., Inc. located in Pittsburgh, Pennsylvania (“Fortunes”) (together with Fortunes, “we”).If an account is opened, the lender on the account will be Fortunes. I understand that the use of an account will be subject to the Terms and Conditions of the Fortunes Credit Agreement that will besent with acceptance confirmation. I agree to be responsible for all charges incurred according to theCredit Agreement. I understand that the terms of my account are subject to change as provided in the Credit Agreement.

I understand that I may submit my application to Fortunes electronically by clicking “Send ApplicationNow” below, or I may apply by fax or telephone. In applying for credit with Fortunes, I authorizethe release of any information about our company from the above references. This information can beused to determine our ability and willingness to pay outstanding invoices within the Fortunes creditof 30 days as outlined in the Credit agreement. If I choose to submit this application electronically,I acknowledge that, regardless of whether I use a web browser with security features, Fortunes is unableto ensure that the data will not be intercepted by third parties. I agree that Fortunes will not be held liable should such interception occur.

A $20.00 charge may be assessed for all NSF checks paid on account.

To request credit terms, please fill out the information to the left. Please note that any fields indicated in red are required fields. Also note that we do not make our mailing list available to outside companies, nor do we promote the use of SPAM mail.