Setup Form For Wholesale Orders @ www.ashleyfoodwholesale.com

Ashley Food Co., Inc, P.O. Box 912, Sudbury, MA 01776

Tel: 978-579-8988 - Fax: 978-579-8989

e-mail: maddog@ashleyfoodwholesale.com

Please fill out this form and e-mail, fax or mail this form

in order to set up an online account for 24/7 Shopping.

Type of Credit Card: Please select one.

Amex

Discover Card

Master Card

Visa

Signature _____________________

Credit Card # ______/______/______/______/______

Exp Date ______/_____

CVC Code _________

(CVC Code = 3 or 4 digit code, generally appears at the end of the Credit Card # on back of Card)

e-mail Address (e-mail address will also be users name)

password ( Please select a password to login to web site)

Bill To: (Bill To Address must be the same as appears on your Credit Card Statement)

Name

Company Name

Street Address

City or Town

State

Zip Code

Phone # Fax #

Delivery To:

Name

Company Name

Street Address

City or Town

State

Zip Code

Phone #