Credit Application – JLM Wholesale

Business Information

Business*

Date*

Business Address*

Street Address Address Line 2 City State ZIP Code

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.

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*

Name

This field is for validation purposes and should be left unchanged.