For the purpose of obtaining merchandise from Seller on credit, the following statement is made intending that you should rely that all information is correct. Fill out completely and if faxed please forward original.
Legal Name
Phone No.
Trade Name
Fax No.
Mailing Address
Cell No.
City
Postal Code.
Amount of Credit Required
email
Owned
Leased
Corporation
Partnership
Limited Partnership
Individual
Owner or Officer
Title
Telephone No.
Owner or Officer
Title
Telephone No.
Owner or Officer
Title
Telephone No.
Bank
Address
Account No.
Tel. No.
Contact
REFERENCES: Please list you current major suppliers (at least 3)
Name.
Address
Phone No.
Fax No.
Contact
The undersigned certifies that the above is true and correct and agrees to pay for all goods purchased in compliance with the terms of the Seller. Unless otherwise agreed to in writing, said terms are that all goods are to be paid in full , 30 calendar days after the invoice date. Should default i n palyment be made when due, the balance plus 2% per moneth (24% APR) on all unpaid sums, together with actual attorney's fee and all costs as the Seller may rasonably incur in the enforcement of the obligation, The undersigned also gives Seller (Jamac Sales ) consent to contact Bank and References for credit purposes to contact Bank and References for credit purposesl