Secure Credit Application & Agreement Form

There are two components to this process, a Credit Application and a Credit Agreement

1. The credit application is included below and collects data to authorize Jetta Corporation to check references and verify banking details to process your credit application.

2. The credit agreement is a downloadable PDF file that requires all relevant stakeholders within the business to participate and sign (either physically or digitally) to consent to financial commitments based on the outcome of the credit application and authorization. Please read the form(s) carefully before submitting.

You can download the credit agreement here. Once it is complete you can upload it into the appropriate space on the form below. Alternatively, if you need to email that document separately after this online form has been submitted, you can email it to accounting@jettacorp.com. Your credit authorization will not be complete until you have been both approved for credit and completed the credit agreement.

Credit Application

Legal Business Name (Include all Trade names, DBA, Division or Subsidiaries)*

Physical Street Address*

City*

State*

Is Mailing Address Same as Street Address? (If Yes, leave next fields blank)*

Yes

Mailing Address

Mailing City

Mailing State

Mailing Zip

Accounts Payable Contact Name*

Accounts Payable Phone Number*

Accounts Payable Email*

All invoices and statements are sent electronically. Please check below if you would prefer paper invoices.*

Send Invoices and Statements by email.

I want paper Invoices and Statements sent to the mailing address provided.

Email address to send Invoices*

Email address to send Statements*

Type of Business*

If Sole Proprietorship or Partnership, enter Names and SS# here

If Corporation / LLC, Enter Key Member Names and SS# here (President, VP, Sec, Treasurer)

If you are exempt from Sales Tax, upload your sales tax exemption certificate here.

Choose file

Upload your completed Credit Agreement here (see top of page for details)*

Choose file

Amount of credit requested*

Number of years in business*

Business Description

If you are a plumber, enter your license # here:

Credit Reference #1 - Business Name, Account #, Contact Person, Contact Email*

Credit Reference #2 - Business Name, Account #, Contact Person, Contact Email*

Credit Reference #3 - Business Name, Account #, Contact Person, Contact Email

The preceding information is for the purpose of obtaining credit and is warranted to be true.*

Yes

The preceding information is for the purpose of obtaining credit and is warranted to be true. I/We hereby authorize Jetta Corporation to investigate all references and customary credit information sourcesincluding consumer credit reporting repositories regarding my/our credit and financial responsibility for
the purpose of obtaining credit and for periodic review for the purpose of maintaining the credit relationship.

CREDIT POLICY: Statements are rendered as of the last day of the month C.O.D. restrictions may be placed on any past due account.

CREDIT TERMS: All invoices are due 20 days from date of invoice. A service charge of one and one half percent (1.5% per month), or (18% per annum)
or the highest legal rate, which ever is less may be assessed on delinquent invoices.

The Federal Equal Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income derives from any public assistance program; or because the applicant has, in good faith, exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with law concerning the credit is the Federal Trade Commission, Division of Credit Practices, 6th and Pennsylvania Avenue, NW Washington, D.C. 26580

In the event of default, and if this account is turned over to an agency and /or an attorney for collection, the undersigned agree to pay all reasonable
attorney fees, and /or costs of collection whether or not suit is filed.

APPLICANT'S SIGNATURE ATTESTS FINANCIAL RESPONSIBILITY, ABILITY AND WILLINGNESS TO PAY IN ACCORDANCE WITH TERMS HEREIN.