Credit Application

Thank you for your interest in opening an account. Please fill out our application. If you have credit references, please upload it.

Company Name *

Business Address *


Street

Apt# / PO Box

City

State	Postal Code

Contact Name *

First Name

Last Name

Phone Number *

ext.

Email Address *

Billing Requirements *

Please check all that apply for invoices to be approved by your Accounts Payable.

Accounts Payable Contact Information

Please supply email, name, tel#/ ext for Accounts Payable contact if different from person filling out credit application. If same, simply write same.

File Upload

If you have a credit reference on file, please upload now. Continue below for some information and agreement.

Business Trade References

If you did not upload your business references, please fill out below. We must have 2 references.

Business/ Trade Reference #1 *

Enter Company Name.

Address


Street

Apt# / PO Box

City

State	Postal Code

Contact Name

First Name

Last Name

Phone Number

ext.

Email Address

Type of Partner

Please advise if they are a vendor or bank

Business / Trade Reference # 2 *

Enter Company Name

Address


Street

Apt# / PO Box

City

State	Postal Code

Contact Name

First Name

Last Name

Phone Number

ext.

Email Address

Type of Partner

Please advise if they are a vendor or bank

Agreement

1. All invoices are to be paid 21 days from the date of the invoice. 2. Claims arising from invoices must be made within seven working days. 3. By submitting this application, you authorize J&D TRANSPORTATION, INC. to make inquiries into the banking and business/trade references that you have supplied. 4. Person filling out below is authorized personell by company applying for credit. 5. Typing name below is equivalent to a signature

Name *

Online Signature approving agreement.

First Name

Last Name

FEIN *

Please provide your company Federal Employer Identification Number.

* SPAM Prevention (please solve the math problem below):

6 + 9 =