Client Intake Form - Juice Marketing

We’re so excited to work with you!

Please take a few moments to fill out Juice Marketing’s client intake form created to grab all essential details to set up your account and best serve your team.

Rest assured all information provided will be kept confidential and please reach out to ar@juicemarketing.com with any questions. Please expand and complete each section and, once finished, click Submit at the bottom of the page.

Company Information:

Legal Business Name:(Required)

DBA:

Billing Address:(Required)

Street Address: Address Line 2: City: State / Province: ZIP / Postal Code: Country:

Website:(Required)

Tax ID#:(Required)

Date Business Commenced:(Required)

Accounts Payable (AP) Contact Information

AP First & Last Name(Required)

First Last

AP Email Address:(Required)

AP Phone:(Required)

AP Title:(Required)

Email for Invoices (if different from above):

Does your company require a Purchase Order?(Required)

Yes

Tax Information:

Tax Status:*(Required)

Reseller: please upload Resale Certificate (Single or Multijurisdiction) or email to ar@juicemarketing.com

Tax Exempt: please upload Tax Exemption Certificate or email to ar@juicemarketing.com

Not Tax Exempt

*if an invalid or no tax exemption form is submitted, sales tax will be applied to your invoices

File Upload:

Drop files here or

Accepted file types: pdf, jpg, png, Max. file size: 50 MB, Max. files: 10.

Credit Terms:

Apply for Credit Terms:(Required)

Yes

No, I will prepay all orders

Credit Terms Application:

Do you have a credit references document to upload containing banking information and at least three references with name, phone, and email contact information for each?(Required)

Yes

No, I would like to enter the information in this form

Credit References Document File Upload(Required)

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 50 MB.

AUTHORIZATION:(Required)

Yes

*I authorize Juice Marketing, LLC to verify credit information provided within this form. I further authorize our banks, trade references, and financial institutions the right to release all credit information requested by Juice Marketing, LLC. I understand that all information obtained by Juice Marketing, LLC will be held in confidence and used solely in assisting and securing credit terms.

*I have read, understand, and agree to the terms outlined in Juice Marketing, LLC’s net terms policy.

JUICE MARKETING NET TERMS POLICY (click to expand)

Purpose: The purpose of this Net Payment Terms Policy is to establish clear guidelines for invoicing and payment procedures between Juice Marketing, LLC and applicant. This policy aims to ensure a smooth and consistent process for the issuance of invoices, receipt of payments, and management of outstanding balances.

Invoicing:

Juice Marketing will provide an invoice to the client via email upon completion of the goods or services.
Net 30 terms, unless otherwise agreed upon, will be applied to all invoices.

Payment Due Date:

Payment for invoices issued by Juice is due within 30 days from the date of the invoice, unless otherwise agreed upon.

Payment Methods:

Juice accepts various payment methods, including but not limited to credit card, bank transfer, wire, and checks.
Payment instructions will be provided on each invoice for convenience.
Any credit card payments over $5,000.00 are subject to an additional service fee.

Late Payments:

Clients are expected to make payments within the defined net terms period; Juice reserves the right to limit client’s credit purchases or to restrict or withdraw client’s credit for failure to pay on time.

Interest and Fees:

Interest on the outstanding balance may be applied at a rate of 1.5% per month until the balance is settled.

Dispute Resolution:

If a client believes an invoice contains errors or discrepancies, please promptly contact Juice to resolve the issue.
Any disputes regarding invoices should be communicated to Juice within fourteen (14) business days from the date of receipt of the invoice.

Confidentiality:

All payment-related information will be treated as confidential and used solely for the purpose of facilitating the payment process.

Amendment and Notification:

Juice reserves the right to modify this policy as necessary; any changes will be communicated to clients in writing.

Business/Trade References (Must Provide Three)

Reference 1:(Required)

Business Name:

Reference 1:(Required)

Contact Name:

Reference 1:(Required)

Phone Number:

Reference 1:(Required)

Email:

Reference 2:(Required)

Business Name:

Reference 2:(Required)

Contact Name:

Reference 2:(Required)

Phone Number:

Reference 2:(Required)

Email:

Reference 3:(Required)

Business Name:

Reference 3:(Required)

Contact Name:

Reference 3:(Required)

Phone Number:

Reference 3:(Required)

Email:

Bank Reference:

Bank Name:(Required)

Bank Contact Name:(Required)

Bank Contact Phone Number:(Required)

Bank Contact Email:(Required)

Bank Account Number:(Required)

D&B Number:

Bank Contact Email:(Required)

AUTHORIZATION:(Required)

Yes

JUICE MARKETING NET TERMS POLICY (click to expand)

Invoicing:

Juice Marketing will provide an invoice to the client via email upon completion of the goods or services.
Net 30 terms, unless otherwise agreed upon, will be applied to all invoices.

Payment Due Date:

Payment for invoices issued by Juice is due within 30 days from the date of the invoice, unless otherwise agreed upon.

Payment Methods:

Juice accepts various payment methods, including but not limited to credit card, bank transfer, wire, and checks.
Payment instructions will be provided on each invoice for convenience.
Any credit card payments over $5,000.00 are subject to an additional service fee.

Late Payments:

Clients are expected to make payments within the defined net terms period; Juice reserves the right to limit client’s credit purchases or to restrict or withdraw client’s credit for failure to pay on time.

Interest and Fees:

Interest on the outstanding balance may be applied at a rate of 1.5% per month until the balance is settled.

Dispute Resolution:

If a client believes an invoice contains errors or discrepancies, please promptly contact Juice to resolve the issue.
Any disputes regarding invoices should be communicated to Juice within fourteen (14) business days from the date of receipt of the invoice.

Confidentiality:

All payment-related information will be treated as confidential and used solely for the purpose of facilitating the payment process.

Amendment and Notification:

Juice reserves the right to modify this policy as necessary; any changes will be communicated to clients in writing.

Signature:

Name:(Required)

First Last

Title:(Required)

Phone:(Required)

Email:(Required)

Signature:(Required)

Date:(Required)

Juice Contact You Are Working With:(Required)