Customer Registration - Nellie's BSFL

1. Company Information

Legal Business Name

Operating/Trade Name (if different)

Head Office Address - Street

City

State/Province

Zip/Postal

Country

Website

General Email

Main Phone Number

2. Primary Business Contact (Official Representative)

Name

Title/Role

Email*

Direct Phone

Authorized to place orders Authorized to negotiate pricing Authorized to sign agreements

3. Additional Company Locations (If Applicable)

Add up to three additional locations.

Location Name/Function

Address

Contact Person

Phone/Email

4. Shipping & Receiving Information

Primary Delivery Address (if different) - Street

City

State

Zip

Receiving Hours

Dock / Forklift Available?

Yes No

Receiving Requirements or Restrictions

Preferred Shipment Size

Full pallet Half pallet Less-than-pallet Bulk

5. Accounts Payable Information

Billing Contact Name

Billing Email

Billing Phone

Preferred Invoice Method

Email PDF EDI / Portal Other

Billing Address (if different)

6. Credit Evaluation (Optional for Prepaid Customers)

Federal Tax ID / EIN

Years in Business

Bank Reference (optional) - Bank Name

Contact

Phone

Trade References

1. Company

Contact

Phone

2. Company

Contact

Phone

7. Product & Compliance Information

Intended Use of BSFL Products

Reptile Feed Pet Treats Poultry/Bird Feed Aquaculture Feed Retail Resale Other

Require third-party lab certificates with each shipment?

Yes No

Require AAFCO, FDA, or state feed compliance docs?

Yes No

8. Authorized Signatory

Name

Title

Date

By submitting, Customer certifies that all information provided is accurate and authorizes IHT to verify references for credit evaluation.

First-time Customer Registration

Thanks — we received your registration.

1. Company Information

2. Primary Business Contact (Official Representative)

3. Additional Company Locations (If Applicable)

4. Shipping & Receiving Information

5. Accounts Payable Information

6. Credit Evaluation (Optional for Prepaid Customers)

7. Product & Compliance Information

8. Authorized Signatory