Credit Application

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Business Information

Business*

Date*

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

Certificate of Resale must be attached*

Please attach you Certificate of Resale as a PDF.

Accepted file types: pdf, Max. file size: 50 MB.

Credit Experience

Trade References*

A minimum of three 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*

Max. file size: 50 MB.

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 at minimum 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*

Business Information

Principal Owners and Officers

Credit Experience

Amount of Credit

Sales Agreement

Business Policies

My Account