Credit Application

J. H. DOWLING, INC.

3019 Jackson Bluff Rd.

Tallahassee, Florida 32304

Phone (850) 222-2616

Fax (850) 222-2617

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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 _____

Other ____________________________________________

*Sub-Contractors, provide name and address of Prime Contractor

    Name _______________________________________________________________________________________

Address _________________________________ City _____________________State _____ Zip ______

Phone ________________________ FAX ________________________

BANK REFERENCE:

Primary Bank Name____________________________________________________________________

Checking Acct. No. ____________________________Loan Acct. No. _______________________________

   Address __________________________________ City _____________________State _____ Zip ______

 Phone ________________________ *FAX ________________________ E-Mail_________________________

 *(REQUIRED)

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: ______________________________________________

 Title:  ______________________________________________

APPROVAL

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.

BY: _______________________________________

Date of approval __________________________________