New Customer - Wholesale & Distributors

new customers

Complete the D&B Customer Credit Application Form

Streamline your grocery supply chain with D&B Grocers’ trusted wholesale distribution services. Complete the D&B Customer Credit Application to access competitive wholesale pricing, reliable delivery, and seamless ordering. Our team is here to support your business with customized solutions and dedicated service.

Please allow up to seven business days for your application to process.

name / address

"*" indicates required fields

Name of Business*
Business Hours*
Street Address*
City*
County*
State*
Zip*
Business Phone*
Business Fax*
Alternate Phone*
Upload Photo of Driver’s License*
Max. file size: 50 MB.

company information
Business Owner*
Phone Number*
Tax ID Number*
If Division/Subsidiary, Name of Parent Company*
Legal Form Under Which Business Operates
Corporation
Partnership
Proprietorship
In business since*
Referred by*
Name of Person Who Places Orders*
Title*
Email Address*

Accounts Payable
Contact Name*
Phone Number*
Fax Number*
Email Address*

Which type of payment options do you prefer? Please select from the following:
Which type of payment options do you prefer? Please select from the following:
EFT/Fintech
Payment upon delivery
*D&B does not accept the following as payment types: Credit card and/or cash.  Payments should be made either through electronic payments or check/money order.
OTHER LOCATIONS – Please list businesses that you own or partner with.
Company Name*
Address*
City*
zip code*
Business Phone*
Contact Name*
Title*
Phone Number*
Company Name *
Address*
City*
zip code*
Business Phone*
Contact Name*
Title*
Phone Number*
Company Name *
Address*
City*
Zip Code*
Business Phone*
Contact Name*
Title*
Phone Number*
I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institutions listed to release necessary information to D&B Grocers Wholesale, Inc. in order to verify the information provided. I further authorize D&B Grocers Wholesale, Inc. to investigate all statements contained herein, and to conduct any and all credit checks it deems necessary. By signing below, each party who is an individual provides written authorization to D&B Grocers Wholesale, Inc. or its designee (and any assignee or potential assignee to obtain such individual's personal credit profile from one or more national credit bureaus.)