Application for credit

Business Name *

Address

Street Address

City *

State *

Country *

Postal code *

Accounting contact *

Phone *

Email *

Billing requirements *

Would you like your invoices emailed?

Yes

if yes, please provide an email

Type of business

Proprietorship

Partnership

Corporation

LLC

Corp. Federal ID#

Under present ownership since

Number of locations

Trade References

1
2
3

Company, Address, Account no. & Phone no.

Bank References

1
2

Bank name, Contact, Account no. & Phone no.

Credit agreement

1- All invoices are to be paid 30 days from the date of the invoice

2- By submitting this application, you authorize JC & 4N'S LLC to make inquiries into the banking and business / trade references that you have supplied.