Please fill out the following form completely and accurately before submitting.
Business
Accounts Payable Contact (if different than above)
Finances
Trade Reference 1
Trade Reference 2
Trade Reference 3
I hereby authorize HempLucid, to verify my credit information provided in this document. I further authorize our
banks, trade references, and financial institutions the right to release by telephone all credit information
requested by HempLucid. We understand that ANY information obtained will be held in confidence. The
requested information will be used solely in assisting and securing credit terms for the applicant.
It is understood and agreed that upon approval, the terms of payment are NET within 30 days from the order
date unless otherwise agreed in writing. Delinquent accounts are subject to a finance fee of 1.5% monthly (18%
annually) until order is paid in full. Terms will only be extended for orders over $500.00. Accounts past due will not
be allowed to place additional orders unless past due balances are satisfied in full. Maximum credit limit is
$5,000.00 unless otherwise agreed in writing. By signing below, you agree to these terms and conditions.