JWF Enterprises
www.BarCodeScannersDiscount.com
116 Kingsley Road
Rochester, New York 14612-5422
Phone (866) 204-1382 Fax (585) 663-9363
eMail: sales@BarCodeScannersDiscount.com

Request for Credit

1) ___________________________________________   ___________________________________________
  Legal Name   Trade Name (if applicable)
  ___________________________________________   ___________________________________________
  Street Address   Mailing Address
  ___________________________________________   ___________________________________________
  City, State                                     ZIP CODE   City, State                                     ZIP CODE
  ___________________________________________   ___________________________________________
  Country   Country
  ( ____ )____________________________________   ( ____ )____________________________________
  Telephone Number   Fax Number
2) Industry
  _______________________________________________________________________________________________
3) Business Established __________   DUNS Number _______________________
4) Company Ownership
(Check One)
 
Corporation ___ S Corporation ___ Partnership ___ Proprietorship ___
___________________________________ ___________________________________
(President/Owner) (Vice President/Owner)
___________________________________ ___________________________________
(Secretary/Owner) (Treasure/Owner)
5) Person to Contact Regarding Payment
 
__________________________________   __________________________________
Name Phone Number                            Ext.
__________________________________   __________________________________
Title Fax Number
6) Requested Credit Limit ________ Projected Annual Purchases __________
Bank Reference
__________________________________   Bank Contact: __________________________
Name On Account (if different)
__________________________________   Account Number: __________________________
Bank Name
__________________________________   Type Of Acct. __________________________
Address
__________________________________   Account Number: __________________________
City/State/Zip
__________________________________   Type of Acct. __________________________
Telephone Number
Trade References  (Please provide complete information)
(Name, Address, Telephone Number)
1. ________________________________________ 2. ________________________________________
  ________________________________________   ________________________________________
  ________________________________________   ________________________________________
  ________________________________________   ________________________________________
  ________________________________________   ________________________________________
3. ________________________________________ 4. ________________________________________
  ________________________________________   ________________________________________
  ________________________________________   ________________________________________
  ________________________________________   ________________________________________
  ________________________________________   ________________________________________
  ________________________________________   ________________________________________
 
I hereby authorize an officer of JWF Enterprises (dba. www.BarCodeScannersDiscount) to collect credit information from the references listed above for the purpose of establishing an account with credit terms.

I understand that the above credit information provided is for the sole purpose of obtaining credit with JWF Enterprises. Furthermore, I certify that the information given is correct and accurate as of the date of this application. I agree and unconditionally guarantee to be held liable for any and all indebtedness accrued under this continuing agreement. All accounts and monies due you shall be due and payable at your place of business, and the terms granted are Net30 unless otherwise agreed upon in writing. All past due accounts, notes or judgements are subject to draw interest at the minimum rate of ten percent (10%) per annum. In the event of default and or referral to a Third Party Collection Agency or Attorney, I agree to pay all costs and fees of such services. Furthermore, I have read and agree to the Conditions of Sale attached to this application. I further understand that failure to pay invoices within terms may result in shipments being held, Cash in Advance terms, or C.O.D. on future shipments.

_____________________________   _____________________________   ______________
Signature   Title   Date
Please allow up to two business days for accounts to established
This form must be accompanied by a purchse order for credit to be established