J&P Hall Express

Credit Application

Date ____/______/______    Company Name ____________________________________________

Billing
Address
 _______________________________________________________________________________

Location
Address
 _______________________________________________________________________________

Telephone # _______________________________    Fax # _______________________________

Type of Business _________________________________________________________________________

Corporation / Individual / Partnership / Subsidiary_________________________________

How Many Years In Business ____    Federal Tax Identification Number ________________

Contact For Account Payable __________________________________________________________

Credit References:
Bank Name And Accounts _____________________________________________________________

Address ___________________________________________________________________________________

Telephone _______________________________    Contact Name _______________________________

Business References:
1) _________________________________________________________________________________________

2) _________________________________________________________________________________________

3) _________________________________________________________________________________________

NOTE: IF CREDIT IS GRANTED, OUR PAYMENT TERMS ARE NET 30 DAYS UNLESS OTHERWISE NOTED

This form can be submitted to Tammy Martin via email (TammyM@JPHallExpress.com) or fax (404-264-6365)