New Customer Information Form

To ensure that you are set up in our system properly, we must receive this form prior to your first order.

Company/Business Information
Mailing Address *
Mailing Address
Delivery Address
Delivery Address
Leave blank if Delivery Address is the same as Mailing Address
Company Contact Information
Owner/Principal Name: *
Owner/Principal Name:
Owner/Principal Phone: *
Owner/Principal Phone:
Payment Contact Name: *
Payment Contact Name:
Payment Contact Phone: *
Payment Contact Phone:
Ordering Contact Information
Ordering Contact Name *
Ordering Contact Name
The person in charge of placing orders.
Ordering Contact Phone: *
Ordering Contact Phone:
Order Reminder Preference *
To help remind you to place an order, select an option for the best method of contact for a reminder.
If you choose "Text Message", please enter a cell phone number in the "Ordering Contact Phone" section.
Confirmation of Information Accuracy
I/we certify that all of the information given above is correct and that I/we fully understand The Bread Shed's Terms & Conditions of Sales and agree to the proper payment. (See below)
Terms and conditions: Payment is due within 30 days of invoice, or balance of $800, whichever comes first. We reserve the right to discontinue service until payment is made if account is not current.