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🟩 Credit Application
Please complete the following information.
Questions? Contact J&I Duct at
937-473-2121
General Information
Business Name
*
Street Address
*
Buyers Name
*
Phone Number
*
Email
*
Receiving Hours
*
If ship-to is different from above
Ship to Name
*
Receiving Hours
*
Appointment Required
*
Appointment Required
Yes
No
Account Information
Accounts Payable Contact
*
Phone Number:
*
Email:
*
OK to email invoices?
*
OK to email invoices?
Yes
No
Hard copy required also?
*
Hard copy required also?
A
Yes
B
No
If bill-to is different from above
Bill to Name
*
Bill to address
*
Business Type
What type of business are you?
*
What type of business are you?
C-corp
S-corp
Partnership
Sole Proprietor
Other
What is your Federal ID #?
*
Tax Status
Tax Status
*
Credit Reference Information
Please supply us with three current trade references
Business Name #1
*
Address
*
Contact Name
*
Phone Number
*
Business Name #2
*
Address
*
Contact Name
*
Phone Number
*
Business Name #3
*
Address
*
Contact Name
*
Phone Number
*
I certify everything is correct on this application to the best of my knowledge.
Your Name
*
Your Title
*
Your Signature
*
Signature
Submit