Business Credit Application Form

Business Credit Applications have payment terms of NET 18 PROX.
An invoice will generate and deliver to your email's inbox with each purchase. Monthly statements are emailed on the 1st of each month and due by the 18th.

"*" indicates required fields

Owner Information

Owner Full Name*

Including middle initial

Owner Title*

Owner Phone*

Owner Email*

Can be the same as Company Info above

Owner Address*

Street Address City State ZIP Code

Bank References

Bank Name*

Bank Contact Name*

Bank Phone*

Bank Address*

Street Address City State ZIP Code

Trade Credit References

Trade Company Name*

Trade Company Contact Name*

Trade Company Phone*

Trade Company Address*

Street Address City State ZIP Code

Trade Company Name 2

Trade Company Contact Name 2

Trade Company Phone 2

Trade Company Address 2

Street Address City State ZIP Code

Additional Information

Tax Exempt?*

Proof of Tax Exemption (File)

Max. file size: 5 MB.

Terms & Conditions

If the account is not paid as agreed or if the credit limit is exceeded, the business charge account will be temporarily suspended, unless other arrangements are made with the store owner or authorized representative.
Repeated late payments may result in permanently revoking your charge privileges.
Payments not received within 30 days of the statement date will receive a service charge of 1.5%.
Invoices are emailed at the time of purchase.
Statements are emailed on the 1st of each month and full payment is due within 18 days of statement/on the 18th day of the month. J.W. Niederauer, Inc. will email a statement each month which will show the unpaid balance for merchandise purchased including any monthly finance charge.
J.W. Niederauer, Inc. may declare the unpaid balance to be due and payable if you default in making any required payment in full when due, and you agree to pay J.W. Niederauer, Inc. (or its agent) all reasonable collection expenses, attorney's fees and court costs incurred in collecting this account.
You must immediately notify J.W. Niederauer, Inc. upon any change in our address or company ownership.

Business Credit Application Form

Company Information

Owner Information

Bank References

Trade Credit References

Additional Information

Terms & Conditions

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