Fillable Credit Application Form (Page 2 of 4) in pdf

Bank Reference

)_________________

Bank Name__________________________________ City/State_________________________ Phone No. (

No.

)___________________

Account No.___________________________ Contact_________________________________ Fax No. ( (

Trade References

Name______________________________________ City/State_________________________ Phone No. (

)_________________

Account No.___________________________ Contact_________________________________ Fax No. (

)___________________

Name______________________________________ City/State_________________________ Phone No. (

)_________________

Account No.___________________________ Contact_________________________________ Fax No. (

)___________________

Name______________________________________ City/State_________________________ Phone No. (

)_________________

Account No.___________________________ Contact_________________________________ Fax No. (

)___________________

Credit Terms and Conditions

The above-named company/individual (“Applicant”) is applying for credit with Jobsite Supply, and undersigned is an authorized

representative of Applicant. Terms of any credit issued pursuant to this application are Net 30 days, unless otherwise stated. Applicant

agrees to pay a time-priced difference charge (sometimes referred to interchangeably as “interest” or “service charge”) of 1.5% per

month (18% per annum) on any unpaid amounts and/or past due invoices. Upon acceptance of this application and the issuance of an

open credit line, Applicant expressly agrees to abide by the credit policies of Jobsite Supply, which policies are subject to change from

time to time at the sole discretion of Jobsite Supply. Applicant agrees to pay all legal expenses incurred by Jobsite Supply in enforcing

this Agreement including, without limitation: reasonable attorney’s fees and expenses, court costs, filing fees, and all costs of collection.

This Agreement is deemed to have been made and entered in the State of Indiana and shall be construed solely in accordance with the

laws of the State of Indiana. If legal action becomes necessary, Applicant agrees that exclusive jurisdiction and venue shall be in the

State Courts of Indiana located in Indianapolis, Marion County, or at the election and sole discretion of Jobsite Supply, any Court which

otherwise has jurisdiction over the Applicant and/or the location of any real estate or project where materials provided by Jobsite Supply

were incorporated or utilized. Applicant submits to the personal jurisdiction of such Courts and waives any defense(s) based upon

jurisdiction or venue therein. Applicant further waives any right to claim incidental, special, punitive or consequential damages against

Jobsite Supply and waives trial by jury.

Applicant acknowledges that it has special skill and knowledge in the selection and use of the equipment and parts to be purchased or

rented from Jobsite Supply and expressly disclaims any reliance upon statements or representations made or to be made by Jobsite

Supply regarding the sale or rental of any parts or equipment. Applicant agrees to provide proof of adequate liability and property

damage (comprehensive) insurance in the form of a Certificate of Insurance prior to commencement of rental. Equipment and all

related materials shall be insured at full value against damage or loss, including vandalism and theft. Applicant is responsible for all

damages to rental items arising from the abuse and/or neglect of its employees or independent contractors. Applicant agrees to pay for

repairs to damaged property or parts of said property at the regular shop rates and part charges of Jobsite Supply. In the event any

rental equipment is damaged beyond repair, Applicant shall be responsible for the regular market value of the property as determined

by similar sales of similar equipment by Jobsite Supply. If Applicant fails to provide Jobsite Supply with proof of insurance coverage

prior to delivery of equipment, Jobsite Supply may, at its sole election, provide insurance coverage with a $2,000.00 deductible for

physical damage only and not liability coverage and may charge 10% of the rental price for said coverage. Any coverage provided by

Jobsite Supply pursuant to this provision does not cover damage to equipment in Applicant’s possession resulting from negligence,

theft or vandalism.

Undersigned, on behalf of Applicant, hereby affirms the foregoing statements are true and correct and understands that any false

information may result in cancellation of any account that may be established. Undersigned understands that Jobsite Supply will rely

on these statements to judge this application; further, by signature below, undersigned authorizes Jobsite Supply to make such

inquiries as it deems necessary in connection with this application, or in the course of review or collection of any payments due, which

specifically includes running credit checks of any person listed above as having an interest in Applicant. By signing below, Applicant

further agrees to abide by the conditions contained herein as well as those stated on Invoices, Statements of Account, and any

Delivery/Return Tickets issued by Jobsite Supply.

Authorized Signature____________________________________ Title___________________________

Printed Name__________________________________________ Date _________________________

Must be signed and dated by an owner or officer of Applicant. A separate form may be required of corporations and LLC’s.

Credit Application Form Page 2

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