It is your responsibility to make sure that the information submitted on this form is accurate.
*Please note that if your business is located outside the state of Louisiana to please place N/A in all banking information sections. You will need to provide a credit card and matching ID for billing prior to shipping. Credit card and ID can be attached below.
Name of Business*
Name of Corporation and/or Legal Entity*
Shipping Address*
Billing Address*
if same as Shipping Address
Phone Number*
Email*
Type of Business*
Restaurant
Grocery/Retail Market
Other
Legal Entity*
Corporation
Partnership
Proprietorship
LLC
Parish/County in which the business is located*
Exempt from Parish/County Taxes?*
Yes
No
Is the business in the City Limits?*
Yes
No
Federal Tax ID (EIN)*
Sales Tax Exemption Certificate* (for LA businesses only) *Must be provided to receive wholesale pricing. Retail pricing will be quoted if not provided or if not exempt.
If yes, MUST PROVIDE A COPY to LA Best Seafood to have on file. Yes
If yes, MUST PROVIDE A COPY to LA Best Seafood to have on file. No
Attach LA Sales Tax Exemption Certificate (parish level and/or state level accepted) *Must be provided to receive wholesale pricing. See above.
Upload document below:
Accounts Payable Contact*
Bank Information*
Credit Card Info and Photo ID Upload (for businesses outside of LA)
Card Type:
Please select card type
Upload Photo ID matching Credit Card below:
Trade References (Major supplies only - Alcohol/Liquor references not applicable)*
Reference 1*
Reference 2*
Reference 3*
Hours of Operation*
Preferred Receiving Hours*
Preferred Delivery Day*
Please select your preferred delivery day. However, your selection does not guarantee we deliver to your area on the selected day. We do have a $250 minimum delivery. Orders below $250 will result in a $10 Fuel Surcharge.Monday
Please select your preferred delivery day. However, your selection does not guarantee we deliver to your area on the selected day. We do have a $250 minimum delivery. Orders below $250 will result in a $10 Fuel Surcharge.Tuesday
Please select your preferred delivery day. However, your selection does not guarantee we deliver to your area on the selected day. We do have a $250 minimum delivery. Orders below $250 will result in a $10 Fuel Surcharge.Wednesday
Please select your preferred delivery day. However, your selection does not guarantee we deliver to your area on the selected day. We do have a $250 minimum delivery. Orders below $250 will result in a $10 Fuel Surcharge.Thursday
Please select your preferred delivery day. However, your selection does not guarantee we deliver to your area on the selected day. We do have a $250 minimum delivery. Orders below $250 will result in a $10 Fuel Surcharge.Friday
Please select your preferred delivery day. However, your selection does not guarantee we deliver to your area on the selected day. We do have a $250 minimum delivery. Orders below $250 will result in a $10 Fuel Surcharge.Saturday
Customers who are out of state and not in an area available to ship via Southwest should choose the option to pick up their orders. Order minimums are waived for warehouse pick up.Pick Up
