J. H. DOWLING, INC.
3019 Jackson Bluff Rd.
Tallahassee, Florida 32304
Phone (850) 222-2616
Fax (850) 222-2617
BUSINESS CREDIT APPLICATION
J.H. Dowling Sales Associate: _________________________________ DATE___________________________
Business Name ___________________________________________________________________________________________
Phone ___________________________ FAX __________________________ E-Mail__________________________________
Street Address______________________________________City _____________________ State ____ Zip ________
Check One: Sole Proprietorship _____ Partnership _____ Incorporated _____
Mailing Address ______________________________________City_____________________ State ____ Zip ________
Billing Address _________________________________City _________________State ____ Zip_____
Accounting Contact Name ________________________________ Phone _______________________
SALES TAX EXEMPTION NUMBER: (If Sales Tax exempt): _________________________________________
FEDERAL IDENTIFICATION NUMBER: ______________________________________________________
Amount of Credit required: ________________________________________________________
TYPE OF BUSINESS: (Check One)
Commercial Contractor _____ Developer _____ *Sub-Contractor _____
Material Supplier _____ Residential _____ Contractor _____
*Sub-Contractors, provide name and address of Prime Contractor
Address _________________________________ City _____________________State _____ Zip ______
Phone ________________________ FAX ________________________
Primary Bank Name____________________________________________________________________
Checking Acct. No. ____________________________Loan Acct. No. _______________________________
Address __________________________________ City _____________________State _____ Zip ______
Phone ________________________ *FAX ________________________ E-Mail_________________________
Please Return application to: Fax - (850) 222-2617 or Mail to the above address.
TRADE REFERENCES: Please list four (4) businesses with which you currently maintain a business credit account.
EXAMPLES: BUILDING/HARDWARE SUPPLY, REDI-MIX, LUMBER, STEEL/REBAR, ETC.
PLEASE DO NOT LIST: RENTAL, AUTO SUPPLY or FUEL OIL COMPANIES AS A REFERENCE.
Please provide NAME, ADDRESS, PHONE, FAX and/or E-MAIL:
1. __________________________________________ Address:__________________________________
Phone: _____________________Fax: ____________________ E-mail: ________________________
2. __________________________________________ Address:____________________________________
Phone: ____________________ Fax: ____________________ E-mail: ________________________
3. __________________________________________ Address:____________________________________
Phone: _____________________Fax: ____________________E-mail: ________________________
4. __________________________________________ Address:____________________________________
Phone: ____________________ Fax: ____________________E-mail: ________________________
BUSINESS OWNERSHIP INFORMATION:
Owners * Partners * Corporate Officers *
Name Home Address Home Phone Title
How long has business operated under current name and ownership? ______________________________________
If less than three years, give previous business activities ________________________________________________
NOTE: All charges shall become due on the 10thof the month following the month of delivery. A finance charge of
One and one-half percent (1-1/2 %) per month will be assessed on any unpaid balance over 30 days.
PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING:
I/we certify that the foregoing information has been supplied truthfully, accurately and voluntarily, and therefore authorize J. H. DOWLING, INC., as the named creditor, to investigate my/our creditworthiness, credit history and financial responsibility through any credit bureau or by any other reasonable means, including direct contact with past and present creditors, I/we also authorize banks and other financial institutions to give information in connection with this application and transaction about my/our savings and checking accounts and loans. As consideration for the extension of credit under this application, I/we agree to make payment promptly in accordance with the terms set forth above. I/we further agree that if an attorney is employed to collect any sums due on the account arising under this application, whether or not suit be brought, I/we shall pay the named creditor a reasonable attorney’s fees, including an attorney’s fee for an appeal, and agree that venue for any cause of action arising under this agreement shall be in Leon County, Florida.
Date of application: ____________________________ Signature: ______________________________________________
J. H. DOWLING, INC. hereby approves the above application for credit in accordance with the disclosures, Representations, terms and conditions set forth therein.
J. H. DOWLING, INC.
Date of approval __________________________________
Files coming soon.