CREDIT APPLICATION – JLB Logistics INC.

CREDIT APPLICATIONadmin2019-03-29T20:58:45+00:00

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Are you an existing customer?*
- Yes
- No

Legal Business Name*
In Business Since*
Legal Form of Company*
- Corporation
- Partnership
- Proprietorship
Billing Street Address*
Billing City*
Billing State*
Billing Zip*
Billing Phone*
Fax*
Email*
Accounts Payable Contact Person*
Preferred Invoice Method*
- Email
- US Mail

Primary Officer Name*
Primary Officer Title*
Primary Officer Street Address*
Company Tax ID Number*
Primary Officer City*
Primary Officer State*
Primary Officer Zip*
Primary Officer Phone*
Primary Officer Email*

Bank References
Institution Name (Checking)*
Checking Account #*
Checking Account Bank Address (Street, City, State, Zip)*
Checking Account Phone*
Institution Name (Savings)*
Savings
Savings Account #
Savings Account Bank Address (Street, City, State, Zip)
Saving Account Phone
Other
Institution Name (Other)
Account Type
Loan Number
Other Institution Address (Street, City, State, Zip)
Other Institution Phone

Trade References
Company Name
Contact Name
Company Address (Street, City, State, Zip)
Company Phone
Account Opened Since
Credit Limit
Current Balance

Trade References 2
Company Name 2
Contact Name 2
Address 2 (Street, City, State, Zip)
Phone 2
Account Opened Since 2
Credit Limit 2
Current Balance 2

Trade References 3
Company Name 3
Contact Name 3
Address 3 (Street, City, State, Zip)
Phone 3
Account Opened 3
Credit Limit 3
Current Balance 3

Signature (First and Last)*
Print (First and Last)
Title*
Date*
MM
DD
YYYY