CREDIT APPLICATION

Return Completed Application To: christine@jcsmithinc.com or Fax: 315-428-9841

Layout MUST PO

Business Name:

Business Start Date:

Tax ID:

Physical Address:

City:

State:

Phone:

Zip:

Fax:

Email:

Referring JC Smith Inc. Salesperson:

Legal Form of Business:

Corporation
LLC
Partnership
Proprietorship

Owner/Officer Name: (1)

Title:

Address:

Phone:

Owner/Officer Name: (2)

Title:

Address:

Phone:

TRADE REFERENCES

Trade Reference 1 - Contact Name & Email Required

Company: *

Address: *

Address Line 2

Phone: *

Account No:

Contact: *

Email *

Fax:

Trade Reference 2 - Contact Name & Email Required

Company: *

Address: *

Address Line 2

Phone: *

Account No:

Contact: *

Email *

Fax:

Trade Reference 3 - Contact Name & Email Required

Company: *

Address: *

Address Line 2

Phone: *

Account No:

Contact: *

Email *

Fax:

PO Required: *

Job# Required: *

Amount Requested: *

Job Location: (Out of state contractors MUST list NY job location)

Local Contact:

Contact Phone:

CREDIT CHECK AUTHORIZATION

By signature of the Officer/Owner/ Partner below, JC Smith Inc. is hereby authorized to fully investigate the credit history of the Company within, including, but not limited to, credit report(s).

Officer/Owner Signature:

Clear Signature

Date:

Print Name & Title:

PERSONAL GUARANTY

Credit Terms are NET 30 Days. Finance charges are 1.5% per month on past due balances. If account becomes delinquent and placed for collection, NYS Law shall govern, Onondaga County shall be Court of Jurisdiction, and legal & Collection Fees incurred will be added to the balance due.

Officer/Owner Signature:

Clear Signature

Date:

Print Name & Title:

CREDIT APPLICATION

Return Completed Application To: christine@jcsmithinc.com or Fax: 315-428-9841

TRADE REFERENCES

Trade Reference 1 - Contact Name & Email Required

Trade Reference 2 - Contact Name & Email Required

Trade Reference 3 - Contact Name & Email Required

CREDIT CHECK AUTHORIZATION

By signature of the Officer/Owner/ Partner below, JC Smith Inc. is hereby authorized to fully investigate the credit history of the Company within, including, but not limited to, credit report(s).

PERSONAL GUARANTY

Credit Terms are NET 30 Days. Finance charges are 1.5% per month on past due balances. If account becomes delinquent and placed for collection, NYS Law shall govern, Onondaga County shall be Court of Jurisdiction, and legal & Collection Fees incurred will be added to the balance due.

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