General Credit Application

Complete the following form, or Download as a Printable PDF, to apply for a general credit account

Personal Information

Name*

First Last

Physical Address*

Street Address Address Line 2 City State ZIP Code

Mailing Address

Same as Physical Address?

Email*

Phone*

Bank Information

Bank Name*

Bank Phone*

Bank Address*

Street Address Address Line 2 City State ZIP Code

Bank Contact*

First Last

Business/Trade Reference 1 of 2

Company Name*

Contact Name*

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Fax

Email*

Business/Trade Reference 2 of 2

Company Name*

Contact Name*

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Fax

Email*

Agreement

Consent*

I agree to the below credit and payment terms*

1) All invoices are to be paid 30 days from the date of the invoice and failure of buyer to make timely payments shall constitute a default.
2) A 1.5% per month finance charge will be assessed to any and all past due balances on the account. Applicant understands and agrees that failure to pay will result in legal action and that the undersigned will be responsible for all collection and associated legal fees.
3) The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of sex or marital status.
4) By submitting this application, you authorize J.M. Davis Industries, Inc. to make inquiries into the banking and trade references that you have provided.
5) In order to establish credit, the applicant must sign this document. By signing you agree that you have legal authority and that you understand the terms of credit and do hereby request that credit be extended by J.M. Davis Industries, Inc.

Your Name*

First Middle Last

Your Title

Hidden

Date*

Phone

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