How to Sell Lady Moon's Organic Produce - Lady Moon Farms: Certified Organic, Soil-Grown Produce

Account Application

Company Name(Required)

Fax

Email(Required)

Mailing Address(Required)

Street Address Address Line 2 City ZIP Code

Phone(Required)

Year Business Started:(Required)

Are you a grower yourself?(Required)

Seasonal or year round?(Required)

Seasonal

Year round

Will you only buy seasonally?(Required)

Yes

If yes, Winter (Oct-April) or Summer (May-Sept)?(Required)

Winter

Summer

Which crops are you interested in? Check all that apply(Required)

Baby Bok Choy

Bok Choy

Cabbage

Cherry Tomatoes

Collards

Cucumbers

Dandelion Greens

Eggplant

Fennel

Grape Tomatoes

Green Bell Peppers

Bibb Lettuce

Green Kale

Green Leaf Lettuce

Jalapeno Chili Pepper

Lacinato Kale

Parsley

Rainbow Chard

Red Kale

Red Leaf Lettuce

Romaine Lettuce

Specialty Tomatoes

Zucchini

Who is AP manager?(Required)

Do you have a food safety manager, if so please provide contact information:(Required)

Description and nature of business:(Required)

Who is your customer?(Required)

Retail

Wholesale

DTC (Direct to Consumer)

Other

Terms and Conditions

Terms are 14 days from date of loading, invoices are emailed. Notice of discrepancy required within 24 hours of receipt. Buyer must provide transportation. 3rd party audit certifications available upon request. Please Note: Remit to address is: Lady Moon Farms, 1795 Criders Church Road, Chambersburg PA 17202

Credit References

Thank you for your information and your time in responding to our request.

Credit Reference 1

Company:(Required)

Address

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Fax

Email(Required)

Accounts Receivable Contact:(Required)

Credit Reference 2

Company:(Required)

Address

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Fax

Email(Required)

Accounts Receivable Contact:(Required)

Credit Reference 3

Company:(Required)

Address

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Fax

Email(Required)

Accounts Receivable Contact:(Required)

Credit Reference 4

Company:

Address

Street Address Address Line 2 City State ZIP Code

Phone

Fax

Accounts Receivable Contact:

Bank Information

Bank information is required for validation.

Account number:(Required)

Bank Branch Phone(Required)

Bank:(Required)

Attn:(Required)

Email(Required)

Fax:

Letter of Release

File(Required)

Max. file size: 50 MB.

Please include a letter of release for your banking institution, they require this letter stating that you give them permission to release the information we are asking for.

Example:

Name

This field is for validation purposes and should be left unchanged.

Please fill out the form below if you are interested in our produce.

We’ve included a snapshot of our produce calendar for your reference.

Click the thumbnail below to see our produce calendar

New Accounts Form

Account Application

Terms and Conditions

Credit References

Credit Reference 1

Credit Reference 2

Credit Reference 3

Credit Reference 4

Bank Information

Letter of Release