J.A.M. Online Credit Application

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Thank you for taking the time to apply for credit with our company.  We will respond as quickly as possible.  If you need assistance, please call us at 713-844-7711 or click here to print out the form, complete it and fax to us at 713-844-7789.
Company Information
Legal Company Name*
DBA Name
Federal ID Number*  
Billing Address*
Suite/Bldg
City, ST, Zip*
County
Phone*  
Fax
E-Mail Address*  
Delivery Information
Delivery Address*  
Suite/Bldg
City, ST, Zip*  
County
Phone*  
Fax
Receiving Hours
Primary Lube Contact Name
Primary Lube Contact Phone
Primary Fuel Contact Name
Primary Fuel Contact Phone
Important: Estimated Monthly Volume (in Gallons)
Fuel (Includes: Diesel, Kerosene, PuriNox)*  
Lubes (Includes: Lubricants, Greases & other Non-Fuel Products)*  
Tax Information
State Sales and Use Tax Exempt?*

 Yes No Copy of exemption certificate must be faxed or tax will be charged.
Fuel Tax Exempt?*

N/A  Yes -Permit Yes -Signed Statement Fax copy of Signed Statement. 

General Company Information
Year Established
Web Address http://
Dun & Bradstreet No. (Call 800-234-3867 for D&B #)
Type of Business*  
P.O. Required?* Yes  No
Bulk Storage Tank*  
How Did You Hear About J.A.M. Distributing?*  
Sales Contact Name
Accounts Payable Information
AP Contact
Title
AP Phone
AP Fax
AP E-Mail Address
Company Owners/Officers
(1) Full Name
Title
Address
City, ST, Zip
Phone
Fax
E-Mail Address
   
(2) Full Name
Title
Address
City, ST, Zip
Phone
Fax
E-Mail Address
   
(3) Full Name
Title
Address
City, ST, Zip
Phone
Fax
E-Mail Address
Credit References - 3 Major Suppliers
(1) Company Name*
Phone*
Address
City, ST, Zip
Fax
Contact Name
Account Number
     
(2) Company Name*
Phone*
Address
City, ST, Zip
Fax
Contact Name
Account Number
     
(3) Company Name*
Phone*
Address
City, ST, Zip
Fax
Contact Name
Account Number
Bank Reference
Bank Name*
Phone*
Account Number*
Address
City, ST, Zip
Bank Officer
Fax
E-Mail Address
Additional Comments
 
Terms & Conditions

Credit Terms (From Date of Invoice):
Net 10 Days - Fuel Products (Diesel, Gasoline, Kerosene, PuriNOx)
Net 30 Days - Lube Products (Lubricants, Greases, Equipment and Other Non-Fuel Products)

This authorization to sell and agreement is submitted by applicant to J.A.M. Distributing Company (J.A.M.) to obtain trade credit.  J.A.M. reserves the right to decline credit to applicant and in the event credit is extended J.A.M. can change or revoke applicant’s credit at any time within J.A.M.’s sole discretion.

In the event that J.A.M. extends credit to applicant, J.A.M.’s acceptance of applicant’s order(s) is expressly made conditional on applicant’s assent to the terms and conditions of this authorization to sell.  The terms and conditions set forth in this authorization to sell will govern all transactions between applicant and J.A.M.  The terms and conditions of purchase order(s) and other similar documents submitted by applicant will not become part of any agreement with J.A.M. unless J.A.M. accepts it in writing. 

J.A.M. has the right to suspend deliveries in the event that applicant fails to pay for any one shipment when due or applicant exceeds the extended credit limit.  The undersigned company agrees to pay all collection costs, court costs, and legal fees incurred to collect delinquent balances. It is agreed that this agreement shall be governed by and construed in accordance with the laws of The State of Texas with venue and jurisdiction in Harris County, Texas.  In addition to any other remedy to which J.A.M. may be entitled, J.A.M. shall be entitled to charge interest at the highest rate permitted by law on any invoice not paid in accordance with all the terms and conditions.  All payables are due in Harris County at P.O. Box 201978, Dallas, Texas  75320-1978.

This agreement is strictly confidential and is not transferable or assignable without the prior written consent of J.A.M.  Applicant agrees that any change in the liability for any debts incurred to J.A.M. due to a change in applicant’s form of business, shall not be effective for J.A.M. until J.A.M. receives actual notice of the change by certified mail.

A $25 fee will be charged to the buyer for returned checks.  Account will be automatically closed if there have been no purchases within one year.

I declare under penalty of perjury that the information on this authorization to sell is correct and that I am authorized to commit applicant to indebtedness and have carefully read the foregoing and understand the same. I further authorize any bank, commercial business or credit reporting agency with whom applicant is doing or has done any type of business to give any and all necessary information to J.A.M. which will assist J.A.M. in the credit investigation.
Acceptance of Terms

By completing the information below, I am attaching my electronic signature to, and our business agrees to, JAM’s terms and conditions contained in the above credit application.  I hereby certify that I am an authorized agent or representative of the company applying for credit and that all the information on this application is correct. I authorize and release all banks, persons, and companies listed on this credit application to furnish information to JAM for the purpose of checking credit.
The Electronic Signatures in Global and National commerce ACT (The E-Sign Act) makes e-signatures as legally binding as ink-and-paper signatures, and can be used in legal proceedings.  By completing the information below and clicking send you will be bond to the terms and conditions set forth in this application.
 

I accept the terms & conditions set forth above.    

Full Name*
Title*
Date*
Phone*
E-Mail Address*