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Customer Application

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Please complete the form below to apply for an account with the Butcher Shoppe. Once received, our team will follow up to complete the application process.

"*" indicates required fields

Billing Address

Billing Name (Ontario Corp. # if applicable)*

Phone*

Email*

Address*

City*

Postal Code*

Is your shipping address different from your billing address?*

Yes

No

Shipping Address

Shipping Name*

Phone*

Email*

Address*

City*

Postal Code*

Additional Information

Name of Hospitality Group (If applicable)

Main Activity (Inc. # of seats if restaurant)

In business since

Building Details

Equipment Details

Ownership / Shareholder information

Owner 1 - Full Name*

Owner 1 - Address*

Owner 1 - Phone*

Owner 1 - Email*

Owner 2 - Full Name

Owner 2 - Address

Shareholder - Full Name

Shareholder - Address

Shareholder - Phone

Shareholder - Email

Contacts

Billing - Full Name*

Phone*

Email*

Shipping - Full Name*

Phone*

Email*

Purchaser - Full Name*

Phone*

Email*

Chef - Full Name (if applicable)

Phone

Email

Credit Terms

Are you seeking credit terms?*

Yes

No

Credit Card Authorization

Please download and fill out the PDF at the following link for us to process your order payments.

Once completed please forward to ar@butchershoppe.com

Download Credit Card Authorization Form

Supplier References

Dry Goods - Full Name*

Terms*

Phone*

Email*

Produce - Full Name*

Terms*

Phone*

Email*

Seafood - Full Name*

Terms*

Phone*

Email*

Requested Payment Terms

Please selected your requested payment terms*

7 Days

14 Days

30 Days

Proposed Method of Payment

Please select the payment method you plan on using*

Credit Card

Direct Deposit

Pre-authorized Debit

E-Transfer

Cheque

Terms & Signature

Terms & Conditions*

I here by have reviewed and agree to the Terms & Conditions for this account application.

Printed Name*

Title*

Signature*

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Customer Application

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Billing Address

Shipping Address

Additional Information

Ownership / Shareholder information

Contacts

Credit Terms

Credit Card Authorization

Supplier References

Requested Payment Terms

Proposed Method of Payment

Terms & Signature

Let's work
together