Credit Application

Business Information
Business*
Date*
Date Format: MM slash DD slash YYYY
Business Address*
Street Address Address Line 2 City State ZIP Code
Date Established*
- Same as Business Address?
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Telephone*
Fax
Email*
Principal Owners and Officers
List Names, Titles and Addresses
Name Title Address
Do you pay sales tax?*
- Yes
- No
Certificate of Resale must be attached*
Please attach you Certificate of Resale as a PDF.
Accepted file types: pdf.
Credit Experience
Trade References*
A minimum of two creditors are required.
Trade Reference Phone Fax Street Address City State Zipcode
Bank Reference*
Bank Officer Name*
First Last
Bank Phone Number*
Amount of Credit
Amount of credit requested*
Enclose a Financial Statement*
Sales Agreement
The undersigned inconsideration for the terms stated herein for the extension of credit by JLM Wholesale, Inc., hereby agrees the terms of sale are "payment in full by the 30th day of the date of invoice." The invoice(s) become past due if not paid by the 30th day of the date of invoice, your account may be placed on hold and sent to our collection department. In the event of default in payment, and if the same is placed in the hands of an attorney for collection, the undersigned agrees to pay all costs of collection, including reasonable attorney's fee. There will be a 25% Restocking Charge on all merchandise returned for credit. The undersigned does hereby certify that the information contained on this application is true and correct, and further agrees that any change in ownership or officers or form that the business operates shall be made known to JLM Wholesale, Inc., 3095 Mullins Ct., Oxford, MI 48371. This notice shall be in writing and mailed to JLM Wholesale, Inc. by certified U.S. Mail.
SIGNED: Company Name*
Name*
First Last
Title*
Comments
This field is for validation purposes and should be left unchanged.

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Name	Title	Address

Trade Reference	Phone	Fax	Street Address	City	State	Zipcode

Business Information

Principal Owners and Officers

Credit Experience

Amount of Credit

Sales Agreement