Hilverda De Boer USA · 109 Danbury road, suite 6, Ridgefield CT 06877 · Phone: 888-220-7248/Fax: 847-416-4783

Hilverda De Boer New Customer Information

To become a client of Hilverda De Boer USA please complete our secure application form, then be sure to click the "Submit" button at the bottom of the page. Thank you.

Legal Company Name *

Trade Name or DBA Name: *

Tax ID [FEIN/EIN]:

Street Address: *

City *

State *

Zip Code *

Phone: *

Fax:

Primary Email Address: *

Confirm Email Address: *

Legal Form of Company (check one): *

Company Hours:

Owner's Name: *

Buyer's Name:

Buyer's Cell Phone Number:

Buyer's Email:

Accounts Payable Contact: *

Accounts Payable Phone: *

Email Address for Invoices & Statements: *

DUNS Number:

Fresh Flower Purchasing Credit Reference(s) - Company name, Phone, Fax & Contact Name:

Preferred Port of Entry

Local Delivery Preference

Commuter airline (provide airport code)

Trucking company (provide company name)

Fed Ex

Airport Code:

Trucking Company Name:

TERMS OF SALE

CREDIT POLICY:

Please inspect all products upon arrival and notify your Sales Representative within 24 hours (no later than our close of business Monday for weekend arrivals) of all issues that may require a credit adjustment to your invoice. Kindly report to your salesperson the invoice number, the date received, and the reason(s) for the credit request.

Email a minimum of three pictures of the product in question to the sales representative as soon as possible. This will assist us in investigating and solving future credits and problems with our growers.

Payment term and account limits:

Check customers are Net 15 Days on invoice date. Credit Card customers are charged weekly on Wednesdays for the previous week's purchases. Credit limit is set at $5,000.

Terms of sale:

Arrival to US Port (JFK, ORD, DAL, LAX and MIA). Selected areas delivery to door as offered.

Auto order limits system:

In the event of customers exceeding credit limits (in days or dollar limit) or missing payment deadlines, salespersons and customer online login will be automatically unable to enter new orders. To resume access and to place new orders, overdue and/or over limit amount on account will need to be paid. Overdue payments are assessed per month at 1% interest.

Minimum orders & charges:

All Dutch orders must total $350 or more in order to be processed. Dutch box charges are $5.75 per box/master (this includes interior ice packing or winter packing). There is a $12.50 clearance fee and a $8.50 Export Agriculture fee per invoice.

Credits:

Hilverda De Boer strives to respond to cutomers immediately and responsibly in order to discuss, solve and settle claims in a timely manner. A prompt notification is necessary in order to investigate the problem and respond appropriately to our customers and vendors.

All our offers and agreements, and the implementation thereof, are governed by the General Terms and Conditions of Hilverda De Boer B.V. These terms and conditions will be sent to you on request free of charge and can also be found on our website (www.hilverdadeboer.com).

Please share this letter and terms with your accounts payable department. Please keep this letter for future reference.

Please sign to indicate acceptance of terms (must be signed by an officer/owner of the company):

Name: *

Title: *

Date: *

PAYMENT PREFERENCE (check one): *

Check by Mail (Net 15 Days on Invoice Date)

Weekly Credit Card Charge (CC users must complete authorization section below. Please fill out ALL items.)

Credit Card Billing Authorization:

Company Name/Name on Credit Card:

Person Authorizing:

Credit Card Type (select one):

Visa

MasterCard

American Express

Credit Card Number:

Expiration Date (MM/YY):

CVV Number (3- or 4-digit code from back of card):

CREDIT CARD BILLING ADDRESS:

Street Address:

City:

State:

Zip Code:

Email Address:

Phone Number:

Fax Number:

Do you currently purchase Dutch flowers? Please select one: *

No, I do not currently purchase Dutch flowers

Yes, via local wholesale

Yes, direct

If you currently purchase Dutch flowers, what is your approximate annual purchasing amount?

$5,000 to $20,000

$25,000 to $100,000

$100,000 +

When do you plan on placing your first order with Hilverda De Boer USA? *

1-2 weeks

2-4 weeks

Just here to Browse

Applicant agrees that all information provided is accurate and complete. Applicant also
acknowledges that all orders may be immediately terminated at Hilverda De Boer's
discretion if any charges are declined or charge backs are claimed against any outstanding
invoiced amount. Disputes to amounts charged on this credit card should be
immediately reported to Maaike Cramer – m.cramer@hilverdadeboer.nl

Changes in status of this card can also be reported to Maaike Cramer.

Please sign below. If you are not equipped to write your signature, please type your name in the space provided just below the signature line.

The undersigned is the duly authorized representative for the credit card provided above.

Authorized signature (if you cannot write your signature here, type it in the space provided below this line):

clear

Typed Signature (if no signature is provided above, your name here will serve as legal authorization): *

Date: *