Consent to Disclose Credit Status and Related Information
I, a legal authorized representative of the customer entity identified below (“ Customer ”), hereby agree and consent to the Customer’s current servicing Sysco company (“ Discloser ”) to disclose or to provide Customer’s credit application and related information to the Sysco subsidiary Edward Don & Company (“ Recipient ”) for the purpose of credit analysis, terms and conditions, issuance of credit, credit review, credit agreement extension, credit renewal and credit risk management. Nothing contained herein shall change any right of the undersigned under the credit application, and such application shall remain in full force and effect, unchanged in its terms and conditions, except with respect to the undersigned’s consent to the disclosure described above.
Customer Legal Name: Trade dba Name: Address:
City/State/Zip:
Current Sysco Location #:
Sysco Account #:
Authorized Representative Signature: Date of Authorization:
E-Mail Address to send invoices to: Do you make purchases for resale? If yes, please provide your resale certificate to set up taxes properly. Do you need t o set up Edward Don & Company in your Supplier (A.P.) master? Do you need a DON W-9? YES NO YES NO YES
NO
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