Wholesale Application Form

Please register your company to access the wholesale areas of our website.

Once your application is reviewed, you will receive confirmation of approval by email. You will then be able to place orders online. Your orders will be packaged and shipped to you via USPS with the next two business days.

Features of being a GoodOnYa Bar Wholesaler

Online price list for wholesale customers only
Order online with the wholesale shopping cart
All bars are made to order

Business Information

Company Name:
Address:
City:
State:
Zip Code:

Shipping Address (if different):
City:
State:
Zip Code:
Phone Number:

Billng Address (if different):
City:
State:
Zip Code:

Accounts Payable Contact:
Phone/Ext:
E-mail:
Resale/Tax Certificate: (REQUIRED)

Please fax a copy of the Resale/Tax Certificate to us at: (858)460-3612
or email to: kris@goodonyadeli.com

Name(s) of Principle Owners or Officers

Name:
Title:

Name:
Title:

Name:
Title:

Bank References

Name of Financial Institution:
Account Number:
Address:
City:
State:
Zip Code:
Contact Person:
Phone Number:

Trade References

Company Name:
Contact Name:
Account Number :
Phone Number :

Company Name:
Contact Name:
Account Number :
Phone Number :

Company Name:
Contact Name:
Account Number :
Phone Number :

Terms and Conditions

Yes I accept these terms and conditions

Terms and Conditions

I understand that my acceptance to these Terms and Conditions constitutes my original signature.

I agree to send a check for the full amount at the end of the 30 days. I agree to accept a finance charge (15% APR) on all past due accounts.

We would really appreciate you putting our web site link on your site to help increase both of our SEO ratings. Please use this back link if you are able to, an/or our website address.

- Back Link: <a href="http://www.thegoodonyabar.com/index.html" alt="Organic Nutrition Bars - The GoodOnYa Bar">Organic Nutrition Energy Bars - GoodOnYa Bar</a>

- Web Address: www.thegoodonyabar.com

I hereby authorize all references to release credit information regarding our company to GoodOnYa, for application purposes. I also agree that should GoodOnYa be forced to hire a collections company to collect my delinquent account balance I am liable for, and will be charged for all costs incurred. I also certify, under penalty of perjury, that all information provided above is true and correct.

Account Info

Requested User Name:
Requested Password: