Request edit access
New Customer Account Form
To be completed by Peppy Hen Calcium & Grit customers
Sign in to Google to save your progress. Learn more
Full Legal Business Name *
Type of Ownership *
State of Formation or Incorporation *
Business Phone Number *
Business Physical Address *
Business Mailing Address *
AP Contact Information: Name, Phone, Email *
Purchaser Contact Information: Name, Phone, Email *
Ordering Instructions: To order products, we require a separate Purchase Order for each shipment using the product codes in our sale sheet. POs should be sent to us via email: gwen@peppyhen.com.  *
Shipping: Peppy Hen bagged products are priced FOB West Jordan, Utah. Peppy Hen tote products are priced FOB Delta, Utah. Upon request, we will provide shipping quotes for full truckload deliveries.
Clear selection
Sales Tax Exempt Status *
Sales Tax Certificate Number  *
Please send a copy of your sales tax exemption certificate for the appropriate states to gwen@peppyhen.com.  *
Invoicing & Payment: Peppy Hen is owned and operated by Certified Materials LC. We invoice our customers through BILL.com, via email to the AP contact listed above. Please ensure that the email address for your AP contact is correct. Invoices may be paid by ACH with no fees, or by credit card with a 3% convenience fee. You do not need a BILL.com account to pay our invoices. *
Our standard terms are 7 days net. We offer up to 30 days net terms on approved credit. To apply for credit, please let us know below and we will send you a credit application.  *
Thank you for doing business with Peppy Hen Calcium & Grit! We are committed to earning your trust and long-term business relationships. Please let us know how we can improve our customer service and support.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Peppy Hen Calcium & Grit.

Does this form look suspicious? Report

Google Forms