Jeg New Customer Credit App

Sales Representative: ___________________________
3. Shipping Address (if different then billing)

Company Name: ______________________________
Address: _____________________________________
City, State. Zip:_________________________________
New Account Application Form
Please complete, sign, and return this form along with Tel. & Fax: ____________________________________
your trade references and financial statement. Attention:_____________________________________
Email:________________________________________
1. Billing Address
Company Name: ______________________________ 4. Ordering Information
Address: _____________________________________ Are Written Purchase Orders Required? . q Yes q No
City, State. Zip:_________________________________ Is Merchandise for Resale? . . . . . . . . . q Yes q No
Tel. & Fax: ____________________________________ Resale Certificate / Tax ID no.: ____________________
Attention:_____________________________________ Purchasing Agent: _____________________________
Email:________________________________________ Email:________________________________________
Tel. & Fax: ____________________________________
2. General Information Accounts Payable Contact:_______________________
Principal/Owner:_______________________________ Email:________________________________________
Social Security #: _______________________________ Tel & Fax: _____________________________________
Email:________________________________________
Telephone: ___________________________________ 5. Bank Information
Company Position: q Individual q Partnership Bank Name: __________________________________
q Corporation q LLC q Sub-Chapter S-Corp Address: _____________________________________
Corporation State of:____________________________ City, State. Zip:_________________________________
Dun & Bradstreet (D&B) no.: ______________________ Bank Officer: __________________________________
At Present Location Since Date: ___________________ Tel. & Fax: ____________________________________
Are Premises Leased? . . . . . . . . . . . . . q Yes q No Account Type: _________________________________
Amount of Credit Desired: _______________________ Account No.: __________________________________
6. Terms and Conditions

All accounts are COD until a credit application has been completed, reviewed, and approved. If any debt is incurred pursuant to this request for credit is not
paid in full when due, the undersigned agrees to pay all costs of collection, including a reasonable attorney's fee. Any balance so remaining unpaid shall
bear interest at the lesser rate of 3% per month or the maximum rate permitted by applicable law, until paid in full.
7. Acceptance and Approval

Signing this agreement indicates your acceptance of the terms and conditions stated. In addition, you authorize JEG & Sons, Inc. to make
any and all inquiries necessary to process this New Customer Application.
Name of Authorized Rep.: _____________________ Title:_______________ Date:________ Signature:____________________________

Please complete, sign, and return this form along with
your trade references and financial statement.
Trade References Trade References

Company Name: ______________________________ Company Name: ______________________________
Address: _____________________________________ Address: _____________________________________
City, State. Zip:_________________________________ City, State. Zip:_________________________________
Tel. & Fax: ____________________________________ Tel. & Fax: ____________________________________
Account Representative:_________________________ Account Representative:_________________________
Account No.: __________________________________ Account No.: __________________________________
Credit Limit: ___________________________________ Credit Limit: ___________________________________
Notes: _______________________________________ Notes: _______________________________________
Acceptance and Approval

Trade References I certify that the above trade references are accurate, true,
and complete. This form has been completed by ourcom-
Company Name: ______________________________
pany as a testament to existing trade references and we
Address: _____________________________________ allow PCS Wireless, Inc. to inquire as to this formslegiti-
macy by contacting any / all of the trade references listed
City, State. Zip:_________________________________
herein. Furthermore, I herby grant permission toPCS Wire-
Tel. & Fax: ____________________________________ less, Inc. to periodically update their trade reference file
in respect to our company by performing randomchecks
Account Representative:_________________________ of our account status with the company's listed above.
Account No.: __________________________________ Should any trade reference listed above change theirac-
count status for our company, we understand that PCS
Credit Limit: ___________________________________ Wireless, Inc. may make any necessary changes as well.
Notes: _______________________________________ Name of Authorized Rep.: _______________________
Title: _________________________________________
Date: ________________________________________
Signature: ____________________________________
Please complete, sign, and return this form along with
your trade references and financial statement.
Bank Reference Financial Statement To be completed by bank officer.

To: __________________________________________ Date Opened: _________________________________
Date: ________________________________________ Average Daily Balance: _________________________
Attention:_____________________________________ Credit Rating: _________________________________
Bank Account No.: _____________________________ Comments: ___________________________________
Company Name: ______________________________
Dear Bank Officer: Our Company is processing an

account application with JEG & Sons Inc. We hereby NSF Check(s): . . . . . . . . . . . . . . . . . . . . . q Yes q No
authorize you to furnish them any bank and /or credit If Yes, How Many? _____________________________
information regarding our account(s), so that they may
adequately evaluate our company. Your prompt If Yes, Last NSF Date: ____________________________
response to this request would be greatly appreciated. Verified By: ___________________________________
Authorized Officer: _____________________________ Title: _________________________________________
Title: _________________________________________ Date: ________________________________________
Signature: ____________________________________ Signature: ____________________________________
Upon Completion Please Fax This Form To:

1.305.468.6534
Notes/Comments:
JEG & Sons Inc. | 20262 NE 15th Ct. Miami, FL 33179 | Tel (305) 654-7555 | Fax (305) 468-6534

Jeg New Customer Credit App

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Sales Representative: ___________________________

3. Shipping Address (if different then billing)

6. Terms and Conditions

7. Acceptance and Approval

Name of Authorized Rep.: _____________ Title:_ Date: Signature:______________________

Trade References Trade References

Acceptance and Approval

Bank Reference Financial Statement To be completed by bank officer.

Dear Bank Officer: Our Company is processing an

Upon Completion Please Fax This Form To:

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