Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

License Expiration *

MM

DD

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Primary Contact Name *

First Name

Last Name

Primary Contact Phone *

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The Primary Contact noted in this form, hereafter known as the Buyer, does hereby agree to the following terms as issued by MFW Wine Co., LLC, 271 Madison Ave, Suite 1404, New York, NY 10016, hereafter known as the Seller: Buyer agrees to honor all terms and conditions of most current price list and assumes all responsibility for attainment of said information. Buyer agrees to pay all invoices pursuant to its accounts whether ordered by the customer or by any person representing himself/herself/itself to be an agent, employee, or representative of the customer. The Buyer agrees to personally guarantee all indebtedness owed to MFW Wine Co., LLC. This guarantee shall be construed as an absolute and unconditional guarantee of payment, without regard to the validity, regularity, or enforceability of any obligation of buyer. Seller shall have its remedy under this guarantee without being obligated to resort first to any security or to any other remedy or remedies to enforce the payment or collection of the said liabilities and may pursue all or any of its remedies at one time or at different times. If this application is executed by a corporation, it includes any and all successor in interest of said corporation and is binding on the same and all successors in interest, now and in the future. In the event of any delinquency of any account, Buyer agrees to pay all collection costs, attorney fees of 25% of the unpaid balance due, and court costs in the collection of said account. Buyer agrees that in the event the customer issues a check which does not clear the collection process, a $30.00 fee shall be added to the Buyer's indebtedness.

I Agree

AP Contact

If different than Primary Contact

First Name

Last Name

AP Contact Phone

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Delivery Contact Name

If different than Primary Contact

First Name

Last Name

Delivery Contact Phone

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Trade Reference Phone

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