Site Index
Home

Concrete Supermarket
   - Products Listing
   - Manufacturers Listing
   - Quote/Order Form

   - Printable Scale Paper
   - C.C. Data


Locations

Who We Are

Trade Associations

Showroom Pictures

Request a Free Catalog

Email Us! info@janell.com

 
Concrete Supermarket: Credit Application


Billing Address    
Business Name:  
Bill to Address:  
City:  
State:  
Zip:  
County:  
Phone:  
Fax:  
     
Shipping Info    
Ship to Address:  
City:  
State:  
Zip:  
County:  
Phone:  
Fax:  
   
Business and Ownership Information
Type of Company    
Ownership:   Individual  Sole Owner    Partnership  
Corporation (Fed Tax Id)
     
Principals    
Name:  
Title:  
Home Address:  
   
Name:  
Title:  
Home Address:  
     
Business Info    
Length of Time in Business:   Years    Months
     
Type of Business   Manufacturer   Supplier  
Other

Is your business Tax Exempt?   Yes (if checked please fax a copy of your Exemption Certificate to Janell, Inc)
     
Reference Information
Bank References    
Name:  
Address:  
City:  
State:  
Zip:  
Phone:  
     
Trade References    
Name:  
Address:  
City:  
State:  
Zip:  
Phone:  
     
Name:  
Address:  
City:  
State:  
Zip:  
Phone:  
     
Name:  
Address:  
City:  
State:  
Zip:  
Phone:  
   
   

Arbitration Agreement: The parties agree to resolve by binding arbitration all claims and disputes arising from or relating to agreements and transactions, including the validity of this arbitration clause. The arbitration shall be governed by the Code of Procedure of Equilaw's National Arbitration Forum (NAF). The applicable Code shall be the Code of Procedure in effect at the time the claim is filed with Equilaw, whose United States administrative office is located at 2124 Dupont Avenue South, Minneapolis, Minnesota 55405, (612) 871-9205. The parties agree to accept service by certified mail, return receipt requested, through the United States Postal Service, of the Initial Claim Documents which begin an arbitration. Judgment upon the Award may be entered in any court having jurisdiction.

THE ABOVE INFORMATION IS FOR THE PURPOSE OF OBTAINING CREDIT AND IS WARRANTED TO BE TRUE. I/WE HEREBY AUTHORIZE THE FIRM TO WHOM THIS APPLICATION IS MADE TO INVESTIGATE THE REFERENCES LISTED PERTAINING TO MY/OUR CREDIT AND FINANCIAL RESPONSIBILITY.

APPLICANTS INITIALS ATTEST FINANCIAL RESPONSIBILITY, ABILITY AND WILLINGNESS TO PAY OUR INVOICES IN ACCORDANCE WITH FOLLOWING TERMS:
FIRM NAME:  
By:   (Initials) (Title)
By:   (Initials) (Title)
   



© Copyright 2006 Janell, Inc.
email: info@janell.com