H.C. SCHMIEDING PRODUCE COMPANY, LLC (“HCS”)
Information Page
Please fill out this page and all attached pages, and email or fax back to us
along with your W9, COI, and MC Authority letter. Be sure to use a
verifiable digital signature or physical signature on all documents.
PO Box 369
Toll Free: 800-643-3604
trucks@schmieding.com
Springdale, AR 72765
Fax: 479-725-6162
INTERNAL USE ONLY:
Vendor Number:
__________________
Approved By: ______________________________
Date: ____________
Company
Legal Name:
_____________________________________
Fed ID or SS#: _________________________________
Address:
_____________________________________
MC #:_________________________________________
Address (cont):
_____________________________________
US DOT #:_____________________________________
City:
_____________________________________
State:
______________ Zip Code: ________
Contact Name:
_____________________________________
Email:
_________________________________
Phone Number:
____________________________ext ______
Fax Number:
_________________________________
Remittance Address:
_____________________________________
Remittance Address (cont): _____________________________________
City:
_____________________________________
State:
______________ Zip Code: ________
Accounting Contact Name: _____________________________________
Email:
_________________________________
Phone Number:
____________________________ext ______
Fax Number:
_________________________________
Does your company use a Factoring Agent? Yes No
Name and Address of Factor________________________
