The Common Market Credit Application

Local Foods Powered by The Common Market

Dear Partner,

We look forward to maintaining your connection to the best local food our region has to offer!

In order to expedite your deliveries of good, fresh local food, and secure an easy payment process, please review the payment options below and indicate which works best for you. Please continue to the next page to fill out the remainder of the application.

Thank you!

We offer the following payment methods:

1. ACH Credit (Preferred Method) You are requesting to transfer money from your account to The Common Market's account, often referred to as a “push”.

2. ACH Debit (Preferred Method) You are giving The Common Market approval to withdraw money from your account, often referred to as a "pull."

3. Check by Mail

o Memo includes invoice number(s)

o Check made out to The Common Market, mailed to:

The Common Market

LBX # 2153

PO Box 95000

Philadelphia, PA 19195-0001

4. Bill.com

o a pp.bill.com/network/commonmarket

o Payment Network ID (PNI) = 0166503521995066

5. Payment with Credit Card

o A 3% processing fee will be added as a line item to each invoice

Bank institution name

For example: TD Bank, PNC Bank

Name of bank account

Name of your account as it appears on bank statement.

ABA routing number

Bank account number

Confirm Bank account number

Remittance email

We will notify you via this email to confirm the financial transaction.

Legal Business Name

DBA Name (if applicable)

Business Address

Street

City

State

Zip Code

Business Type

CorporationPartnershipIndividual

Principal Officer Name

Phone Number

Accounts Payable Information

Billing Contact Name

Phone Number

Email Address

Your Signature

By typing my name in the box below, I authorize The Common Market Great Lakes, Inc. and its Affiliates to debit the designated bank account in payment of all invoices per agreed terms of sale. This authorization will remain in full force and effect until The Common Market Great Lakes has received written notification from my company 5 business days prior to the effective termination date. I also understand that all declined/ returned payments will be subjected to a $35 transaction fee.

Name:

Date

Title

Contact Information