Vibe Restaurant Group Application for House Account
Customer Name *
(If you represent an organization, please use the organization's name.
Your answer
Customer is (please indicate one): *
Customer Address *
Your answer
Customer Telephone *
(Please included area code)
Your answer
Primary Contact Person *
Your answer
Primary Contact Email *
Your answer
Is customer exempt from sales tax? *
If yes, please provide a copy of the organization's current tax exempt certificate.
Your answer
I hereby certify that I am a representative of the customer described above and that I am authorized to establish this account and bind the organization to the terms thereof. I also certify that I have been provided a copy of the Customer Information Sheet and understand the terms and conditions therin. *
Digital Signature
Your answer
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