Credit App


	If you are a new J.W. Equipment customer and would like to purchase equipment & parts on credit, we will require additional information from you. Please complete our online Credit Application form below and then click the "Submit" button. You will be contacted by J.W. Equipment within 5 business days regarding your application. The following information must be completed in full. All information will be held in strictest confidence and will not be shared with any other third parties without your expressed written consent. Company Info First Name: Last Name: Your Title: Company Name: Street Address: City: State/Province: Zip (Postal) Code: Country: Telephone (begin with Area Code): Fax: Email Address: Web Site: Number of Years in Business: Number of Years at Current Address: Banking Info Name of Your Bank: Street Address: City: State/Province: Zip (Postal) Code: Country: Telephone (begin with Area Code): Fax: References Name of Reference #1: Street Address: City: State/Province: Zip (Postal) Code: Country: Telephone (begin with Area Code): Fax: Name of Reference #2: Street Address: City: State/Province: Zip (Postal) Code: Country: Telephone (begin with Area Code): Fax: "I (we) certify that the above information is true & accurate, and that I (we) can & will comply with your credit terms. Thank you for submitting this information. When you've finished completing this form, please click on the "Submit" button below.