Company Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Business Phone *

(###)

###

####

Product Standards *

Please check the box next to each standard that your brand or product(s) meet. You can review MFC's product standards at: medfordfood.coop/product-standards

No artificial flavors, colors, or preservatives

No GE/GMO ingredients

Certified Organic

Local (within 100 miles)

Regional (from Oregon or within 200 miles)

Grass-Fed

Vegetarian-Fed

Fair Trade

Gluten Free

Dairy Free

Vegan

Vegetarian

Keto

Paleo

Raw

None of the above

Payment Terms *

We process payments once each week with Net30 terms to cut down on processing and mailing. Depending on your delivery schedule, this may include multiple invoices. Contact bookkeeper@medfordfood.coop to discuss whether or not different terms may be possible.

ACH

Online

Check

Contact Name *

First Name

Last Name

Contact Phone *

(###)

###

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Are you the business owner or the primary contact? *

Please check all that apply.

Business Owner

Primary Contact Person

Are you the contact person for order fulfillment? *

Yes

No

Are you the contact person for accounts receivable? *

Yes

No