THOMAS & HOWARD COMPANY Columbia Division PO Box 23659 • Thomas Flint Lake Road • Columbia, SC 29223 803-788-5520 • 800-251-1383 • Fax: 803-699-9097 New Account Application
Please select the applicable division Foodservice Distribution Convenience Distribution - Columbia Convenience Distribution - Spartanburg
E-mail Address
Legal Business Name		Date (mm/dd/yy)
Phone		Fax
Billing Address
Address
City		State		Zip
Shipping Address
Address
City		State		Zip
Individual Owner
Name (Full)		Address
City		State		Zip
SS No.
Partnership (List All Partners)
1. Name (Full)		Address
City		State		Zip
SS No.
2. Name (Full)		Address
City		State		Zip
SS No.
3. Name (Full)		Address
City		State		Zip
SS No.
4. Name (Full)		Address
City		State		Zip
SS No.
Corporation
Legal Corporate Name
State of Incorporation		Date of Incorporation
Officers
President		SS No.
Vice President		SS No.
Secretary		SS No.
Treasurer		SS No.
Registered Agent
Name		Address		Phone
City		State		Zip
Trade References
1. Name		Address
City		State		Zip
2. Name		Address		Phone
City		State		Zip
3. Name		Address		Phone
City		State		Zip
4. Name		Address		Phone
City		State		Zip
Name of Bank
Name		Address
City		State		Zip
Name of Banker
Name		Phone
Sales Tax Certificate No.		State
Your Thomas & Howard customer representative will obtain additional information during the first visit including merchandising information, transportation schedules, T&H profit programs, copy of sales tax certificate, signed personal guarantee of payment and other information as may be required.