Credit Application

Use the form below to inquire about credit opportunities with our company.

Your Personal Information
Company Name*
Phone*
Fax #*
Address*
Street Address Address Line 2 City State ZIP Code
Principle Owners/Partners*
Contact Email*
Type of Business*
About the Business*
Type of Business How Long in Business?
About Your Bank Accounts (Click the + button to add a new row)*
Bank Name Branch Account # Phone #
References
List 3-5 people we may contact who are qualified to evaluate your capabilities. Do not include relatives. (Click the + button to add a new row)
Name Address Occupation Years Known
Day of the Week Payments are made?*
- Monday
- Tuesday
- Wendsday
- Thursday
- Friday
Acknowledgement
PLEASE NOTE:

Our terms are 30 days

There is a 1.5% charge on your balance due over 35 days Please pay promptly in order to avoid late fees

J & L Transportation, Inc. may place a lien on debtors' property to secure payment of unpaid freight and other Transportation related charges.
Your Signature*
Use your mouse or finger to sign
Today's Date*
MM slash DD slash YYYY

Bank Name	Branch	Account #	Phone #

Name	Address	Occupation	Years Known

Your Personal Information