Wholesale Application

Please fill out the form below to apply for a wholesale account with Pepper Creek Farms. Upon submitting this form you will receive an email with a credit application that also needs to be filled out and returned in order to process your account. General account Net 30 set up time is 3 weeks.

Credit Application must include Banking Information and 3 Trade References. Thank you for applying @ Pepper Creek Farms!

NOTE: If you already have an account with us, please login at the login page.
Your Personal Details * Required information
First Name:  *
Last Name:  *
E-Mail Address:  *
Street Address:  *
City:  *
Zip Code:  *
Country:  * (State Dropdown will auto-update when changed)
Contact Information
Telephone Number:  *
Fax Number:  
Company Details
Company Name:  *
Company's tax id number:  *
Class of Business *   Proprietorship  Partnership  Corporation
New Owner
Purchase Date
Length of Time in Business
Business Year *   Seasonal  Year Round
Type of Business *
  Gourmet Food Store   Department Store
  Baskets   Restaurant/Caterer
  Gift Shop Other  
Your Password
Password:  *
Password Confirmation:  *