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General Credit Application
Commercial Credit Application
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Alabama
Alaska
American Samoa
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Florida
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Hawaii
Idaho
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Northern Mariana Islands
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Utah
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Vermont
Virginia
Washington
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Armed Forces Americas
Armed Forces Europe
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State
ZIP Code
Email
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Phone
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Bank Information
Bank Name
*
Bank Phone
*
Bank Address
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Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Bank Contact
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First
Last
Business/Trade Reference 1 of 2
Company Name
*
Contact Name
*
Mailing Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Fax
Email
*
Business/Trade Reference 2 of 2
Company Name
*
Contact Name
*
Mailing Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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.
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