Credit Application

Company Information:

Company or Firm Name (required)

Year Established (required)

Business Type (required)

Name of Owner(s) (required)

If corporation, names of corporate officers:

President

Vice President

Treasurer

Type of Business (required)

Address (required)

City (required)

State/Zip

Phone (required)

Fax (required)

Email (required)

Business References:
Reference 1:

Name

Account #

Address

City

State/Zip

Phone

Fax

Reference 2:

Name

Account #

Address

City

State/Zip

Phone

Fax

Reference 3:

Name

Account #

Address

City

State/Zip

Phone

Fax

 I accept the terms of this agreement.
By checking this box, I agree to all credit-terms of my account as set forth by Produce Services of Los Angeles. PSLA agrees to notify me via email should any conditions of the agreement change. Both I and PSLA agree that the account may be deactivated by either party at any time without notice. You may review our privacy policy here.

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Credit Application