Please email completed forms to [email protected]Location: 9895 Double R Blvd Reno, NV 89521 Telephone (877) 914-2705 Fax (775) 345-3696 Do you have a Sales Representative? If yes, please name __________________________ BASIC INFORMATION Applicant's Business Name Phone FAX Street Address City, State & Zip Parent Co. ( if Subsidiary ) Credit Amount Requested $ Mailing Address City, State & Zip Name / Contractor License Holder Contractor License # / State Date Company Started Federal Tax ID # Tax Resale # (Please attach a copy) Website Trade References: (Required) Three active supplier references (open accounts only) 1 Your Account # Business Address Zip Code Phone # FAX # Credit Dept Contact Email 2 Your Account # Business Address Zip Code Phone # FAX # Credit Dept Contact Email 3 Your Account # Business Address Zip Code Phone # FAX # Credit Dept Contact Email Principals: (Required) Name Title Address Phone Email address Arizona Northern CA Southern CA Northern NV Southern NV Hawaii CUSTOMER INFORMATION SHEET Name of Company City & State City & State City & State Name of Company Name of Company (VWLPDWHG $QQXDO 9ROXPH $ Do you have an order pending? Yes No Banking Reference: (Required) To be completed on Page 3 of the application Oregon Revised 5/01/2020 1 of 3
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CUSTOMER INFORMATION SHEET - Jensen Precast · Applicant's Business Name Phone FAX Street Address City, State & Zip Parent Co. ( if Subsidiary ) ... (es) Email address 1 Email address
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*** If you are purchasing for resale please attach a signed resale card. ***
Terms are NET 30 DAYS. On all credit sales, payment in full is due within 30 days after Customer's receipt of materials or services. Customer agrees to pay a service charge of 1.5% per month on all invoices not paid when due. This is an annual percentage rate of 18%. At its option, Jensen Precast may decline to make delivery or shipment to Customer if any invoice remains past due. I/we agree to pay any and all reasonable costs of suit, attorney's fees and costs, collection fees and costs necessary to collect on this account if payment is in default. All sales subject to Jensen Precast terms and conditions of sale which may be found at https://www.jensenprecast.com/legal/. Risk of loss on product sales will not transfer to customer until full payment is received by Jensen Precast, however, responsibility for the product itself will transfer to customer upon receipt of possession.
Applicant(s) hereby authorizes above referenced and any credit reporting agency to release all information relative to our creditarrangements to Jensen Precast.
In consideration of credit granted, the undersigned personally guarantees any and all charges and/or money due. This sum to include reasonable attorney's fees and collection fees and costs.
Thank you for your assistance in this matter. We appreciate your time. Please return this form by fax at 775-345-3696 or by email at [email protected] at your earliest convenience.