Hy-Vee In-Store Charge Application for Businesses
This document is essential for businesses and non-profits applying for an in-store charge account with Hy-Vee. It includes needed customer and bank information, along with terms and conditions. Properly completing this application ensures smooth account setup.
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How do I fill this out?
To fill out the Hy-Vee In-Store Charge Application, carefully provide your business information at the beginning. Next, enter billing and bank information, if applicable. Lastly, ensure to sign and date the application before submission.

How to fill out the Hy-Vee In-Store Charge Application for Businesses?
1
Print the application form.
2
Fill in your business and customer information.
3
Provide billing information as needed.
4
Complete the bank information for automatic payments if desired.
5
Sign and date the application.
Who needs the Hy-Vee In-Store Charge Application for Businesses?
1
Small businesses applying for a charge account.
2
Non-profit organizations seeking credit for supplies.
3
Large corporations needing a streamlined payment method.
4
Local community groups wanting to purchase goods on credit.
5
Sports teams requiring funds for uniforms and equipment.
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What are the instructions for submitting this form?
To submit this form, mail it to Hy-Vee Accounts Receivable at 5820 Westown Parkway, West Des Moines, IA 50266-8290. You can also submit it in person at your nearest Hy-Vee store location. For questions, contact Hy-Vee customer service for guidance.
What are the important dates for this form in 2024 and 2025?
Important dates for submission will be highlighted for the years 2024 and 2025 and will include deadlines for application processing and any relevant promotional events.

What is the purpose of this form?
The primary purpose of this form is to facilitate the setup of in-store charge accounts for businesses and non-profit organizations at Hy-Vee. By providing essential business and billing information, applicants can ensure they receive prompt payment processing and account management. The terms and conditions included in the application outline the responsibilities and privileges associated with account use.

Tell me about this form and its components and fields line-by-line.

- 1. Last Name/Company Name: Enter the last name or company name of the applicant.
- 2. First Name: Specify the first name of the applicant.
- 3. Address Line 1: Provide the first line of the address.
- 4. Address Line 2: Include any additional address information.
- 5. City: Enter the city of residence or business.
- 6. State: Select the applicable state.
- 7. Zip: Fill in the zip code.
- 8. Phone: Provide a contact phone number.
- 9. Bank Name: Input the name of the bank.
- 10. Routing Number: Provide the bank routing number.
- 11. Bank Account Number: Enter the associated bank account number.
- 12. Tax ID Number: Fill in the tax identification number if applicable.
- 13. Authorized Signature: Sign the application to validate it.
- 14. Date: Date of the application submission.
What happens if I fail to submit this form?
Failure to submit this form may result in disqualification from obtaining a Hy-Vee charge account, which can impact purchasing capabilities. Incomplete forms will delay the account setup process, impacting the organization's ability to obtain goods and services on credit.
- Delayed Processing: Incomplete or incorrect information can cause delays.
- Account Denial: Submitting an incorrect application may lead to denial.
- Loss of Purchasing Privileges: Without an approved account, organizations may lose purchasing options.
How do I know when to use this form?

- 1. Regular Business Procurement: For businesses needing regular supply purchases.
- 2. Non-Profit Operations: To facilitate goods procurement for organizational needs.
- 3. Event Planning: When purchasing items for specific events, a charge account allows convenience.
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