Credit Application

CREDIT APPLICATION

Business Information

* Indicates required field

Business Name: *

DBA *

Business Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Date Business Established: *

Principal Owners and Officers

One required

Name *

First

Last

Name *

First

Last

Name *

First

Last

Name *

First

Last

Title: *

Title *

Do you pay sales tax? *

Yes No

If no, upload certificate of resale as a PDF *

Max file size: 20MB

FEIN *

Credit Experience

Trade References
Three creditors required

Trade Reference *

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Trade Reference *

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Trade Reference *

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Bank Reference

Bank Name *

Bank Officer Name *

First

Last

Bank Phone Number *

Amount of Credit

Amount of credit requested *

Sales Agreement

The undersigned inconsideration for the terms stated herein for the extension of credit by Instant Jungle LLC, hereby agrees the terms of sale are "payment in full by the 30th day of the date of invoice." The invoice(s) become past due if not paid by the 30th day of the date of invoice, your account may be placed on hold and sent to our collection department. In the event of default in payment, and if the same is placed in the hands of an attorney for collection, the undersigned agrees to pay all costs of collection, including reasonable attorney's fee. There will be at minimum a 25% Restocking Charge on all merchandise returned for credit. The undersigned does hereby certify that the information contained on this application is true and correct, and further agrees that any change in ownership or officers or form that the business operates shall be made known to Instant Jungle LLC, 1700 N Batavia Street, Orange, CA 92866. This notice shall be in writing and mailed to Instant Jungle LLC by certified U.S. Mail.

Name *

First

Last

Title *

Application Date: *

Authorized E-Signature (type full name) *

By inputting your name on the "Authorized E-Signature" line, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement, and you consent to be legally bound by this Agreement's terms and conditions.

Additional Comments *

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