Home 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 Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific 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?* MondayTuesdayWendsdayThursdayFriday 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* © 2015 J&L Transportation | All Rights Reserved