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New Customer Form

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Distributor | Wholesaler

Grocery or retail store

COMPANY NAME

FIRST NAME

EMAIL ADDRESS

LAST NAME

FAX NUMBER

Tax ID#

PHONE NUMBER

WBESITE

ADDRESS

COUNTRY

CITY

YOUR SMILE GROUP SALES AGENT NAME

STATE

ZIP CODE

DELIVERY OPTION * Required

Lift Gate

Dock with Forklift

ACH, sign the attached ACH form to authorize us to process the payment upon your approval. “ACH form is attached at the end of this letter if needed”

Send a check directly to our office at: Smile Group LLC, 6360 Sunfish Lake Court, Ramsey, MN 55303.

Email us a printable check to Info@SmileGroupUSA.com with detailed payment info.

Through our easy payment system in Quick Book, simply open the invoice that will be attached to your email and click PAYNOW to make payments.

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A 3% processing fee will be applied for all credit card payments. “Credit card form is attached at the end of this letter if needed”

The shipping address is NOT the same company address

Bank Transfer & ACH Authorization Form

I authorize Smile Group LLC, to electronically debit my bank account

According to the terms outlined below. I acknowledge that electronic debits against my account must comply with United States law.

Bank Information

Personal

Business

Checking

Savings

Bank Name

Account number

Routing number

Card Authorization Form

I give permission to Smile Group LLC, to charge my card for the my

purchases. My card details will be stored in my profile and will only be used for my future purchases.

Card Information

Master Card

Discover

Visa

Amex

Account type

Personal

Business

Card number

Exp Date

/

Name of card

SHIPPING ADDRESS IF DIFFERENT

COUNTRY

STATE

CITY

ZIP CODE

I agree to all the terms and policy of using the site also mentioned above

NAME

TITLE

SIGN

DATE

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New Customer Form

Home
Product
Recipes
Gallery
About
Contact Us
More

Use tab to navigate through the menu items.

New Customer Form

bottom of page

Takes approximately 5 minutes

Bank Transfer & ACH Authorization Form

Bank Information

Bank Name

Account number

Routing number

Card Authorization Form

Card Information

Account type

Card number

Exp Date

/

Name of card

The data has been sent successfully

There is a problem with one of the mandatory fields

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New Customer Form