APPLICATION FOR OPEN ACCOUNT BILLING
Please complete the following application if you would like your orders shipped on an open account basis with net 30 terms. Your application will be reviewed by our credit department immediately for consideration. Please fill this form out completely.
Indicate Division of Purchase
SPORTSWEAR □ OUTDOOR □ WHOLESALE BLANKS □
Business Name:
Name of Contact:
Address:
City: State: Zip:
Phone #: Fax #:
Name of Parent Company (if subsidiary):
City: State: Zip:
Do you require a Purchase Order number on your orders or invoices? Yes / No
A/P Contact: Phone: Email:
Indicate Business Type: Proprietorship □ Partnership □ Corporation □ Gov’t Agency□
If proprietorship, please include Social Security number:
Type of Business: Year Established:
Approximate Net Worth: Annual Sales:
Names of Principles of business and titles:
D&B Number: ASI Number:
PPAI Number:
Name of Bank: Account #:
Address: City: State:
Phone Number:
Current vendors utilized with open accounts:
1. Name: Address:
Fax Number: Account #:
2. Name: Address:
Fax Number: Account #:
3. Name: Address:
Fax Number: Account #:
Terms and Conditions Net 30 Days (unless otherwise approved).
The undersigned hereby warrants that all information provided herein is, to the best of their knowledge, in all respect complete, accurate, and truthful. The undersigned hereby agrees to comply with terms and conditions of sale and agrees to pay interest at a rate of 1.5% per month (18% annual percentage rate) on any past due balance and to pay all collection costs, attorney fees, and court costs incurred in the course of collection any past due balance.
Signature of Principle Print Name Date
(By signing, we authorize J. America to obtain credit information from our bank and vendors)
Accounting Location: Contacts:
J. America, LLC Attn: Credit Dept. Alisha Spencer x153
445 Van Riper Rd
Fowlerville, MI 48836 Jill Kiley x113
Phone: 517-219-0220
Fax: 517-521-1904 or 517-223-8374
J. America, LLC 1200 Mason Court, Webberville, MI 48892 Ph: (517)521-2525, Fx: (517)521-2605