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Credit Applications - Your Choice
Mon Aug 10 1998

Bullet Consumer - Contractor - Industrial/Commercial
These Revolving Credit Accounts allow you to pay a minimum monthly payment or the balance in full. Call us at (502) 458-3241 or e-mail info@jeffersonlumber.com . We will mail or fax you the appropriate application today. Instant Credit is available upon request at 1-888-222-2171. Call and give information for store #81574000.

Jefferson Lumber Company Credit Application
4406 Poplar Level Road - Post Office Box 33337 - Louisville, Kentucky 40232-3337
(502) 458-3241 - (800) 854-7934 - (502) 458-3245 Fax
Http://www.jeffersonlumber.com * Sales@jeffersonlumber.com

All information must be completed in full before application will be processed.
Company Date
Mailing Address
PO Box
City State Zip
Phone Fax
Shipping Address
Address Line 2
City State Zip
Phone Fax
E-mail Web Page
· Circle One: Corporation Partnership Individual

Officers, Partners, or Owners: ( complete information necessary )
Title
Name
Home Address
City State & Zip
Phone
S. S. #
Use Separate Sheet for additional listings and attach.

Miscellaneous:
Circle One Own Rent Building From Whom
Real Estate Value: $ Monthly Mortgage
Real Estate Mortgagee

Amount of Credit requested:


Trade References: (complete information will speed up processing)
Name:
Address 1
Address 2
Phone
Fax
Contact
Account#
Name:
Address 1
Address 2
Phone
Fax
Contact
Account#
· Use additional paper if necessary and attach. At least 4 current references required to process.


Bank Information: (Account Numbers & Complete Information Required)
Name
Address City St Zip
Phone Fax
Contact
Account #


Additional Information:
· D&B Number: Rating: Date:
· State or Federal Tax Liens: (over past 5 years)
· List or state “none” if applicable.


· Law Suits or Judgments: (over past 5 years)
· List or state “none” if applicable.


Additional Agreements:
· Purchase Order Number Required: (circle one) Yes No initial:
If No - I/we agree to pay all invoices charged to our account.
· Provide & Update a List Authorized to Charge: (circle one) Yes No initial:
If No - I/we agree to pay all invoices charged to our account.
· Identification Required to Charge to Your Account: (circle one) Yes No initial:
If No - I/we agree to pay all invoices charged to your account.

Note: If you refuse Guaranty write refused: If turned down we have revolving accounts or cash.
Date:Individual Personal GuarantyI, residing at , for (name) (address)and in consideration of your extending credit at my request to (name of your company) ( hereinafter referred to as the “ Company” ) of which I am , hereby (title)Personally guarantee payment, to Jefferson Lumber Company Inc., Louisville, Kentucky, of any obligation of the Company and I hereby agree to bind myself to pay you on demand any sum which may become due to you by the Company whenever the Company shall fail to pay the same. It is understood that this guarantee shall be a continuing and irrevocable guarantee and indemnity for such indebtedness of the Company. I do hereby waive notice of default, non-payment, and notice thereof and consent to any modification or renewal of the credit agreement hereby guaranteed. This guaranty covers a maximum aggregate liability of $ and will terminate . ( total credit needed ) ( maximum of 3 years ) If suit is brought to collect this account, Jefferson Lumber Co., Inc. shall be entitled to collect all reasonable costs and expenses of suit, including, but not limited to, reasonable attorney’s fees. I also agree to pay the monthly service charge of 1-1/2% on any balance not paid by the end of the month following the date of invoice noted on each monthly statement. Signature Signature Signature Witness


Other Requirements:
Financial Statement Available: (circle one) Yes No If yes please enclose.
Pay all finance/service charges: (circle one) Yes No Yes implies guarantee
Pay collection and Attorney fees: (circle one) Yes No Yes implies guarantee

The above information is for the purpose of obtaining credit and is warranted to be true. I/we authorize the person or firm to whom this application is made to investigate the references listed pertaining to my /our credit responsibility. I have reviewed and submit as correct.

Name: Title: Signature: Date:





Release of Information to Process Credit Application
I , Hereby authorize the release of credit information to Jefferson Lumber Company for the sole purpose of opening a charge account. All information will be kept in strict confidence and used only by the credit department for processing this credit application. I agree to release the supplier of this information from any liability involved with this process. I appreciate your prompt response in this matter.
Sincerely,









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