APPLICATION FOR OPEN ACCOUNT BILLING

Please complete the following application if you would like your orders shipped on an open account
basis with net 30 terms. Your application will be reviewed by our credit department immediately for
consideration. Please fill this form out completely.

Business Name:

Name of Contact:

Address:

City: State: Zip:

Phone #: Fax #:

Name of Parent Company (if subsidiary):

City: State: Zip:

Do you require a Purchase Order number on your orders or invoices? Yes / No

A/P Contact: Phone: Email:

Indicate Business Type: Proprietorship □ Partnership □ Corporation □ Gov’t Agency □

If proprietorship, please include Social Security number:

Type of Business: Year Established:

Approximate Net Worth: Annual Sales:

Names of Principles of business and titles:

J. America Wholesale Blanks 445 Van Riper Rd, Fowlerville, MI 48836 Ph: (517)521-1105, Fx: (517)223-8374
D&B Number: ASI Number:

PPAI Number:

Name of Bank: Account #:

Address: City: State:

Phone Number:

Current vendors utilized with open accounts:

1. Name: Address:

Fax Number: Account #:

2. Name: Address:

Fax Number: Account #:

3. Name: Address:

Fax Number: Account #:

Terms and Conditions Net 30 Days (unless otherwise approved).

The undersigned hereby warrants that all information provided herein is, to the best of their knowledge,
in all respect complete, accurate, and truthful. The undersigned hereby agrees to comply with terms
and conditions of sale and agrees to pay interest at a rate of 1.5% per month (18% annual percentage
rate) on any past due balance and to pay all collection costs, attorney fees, and court costs incurred in
the course of collection any past due balance.

Signature of Principle Print Name Date

(By signing, we authorize PJWB, LLC / J. America Wholesale Blanks to obtain credit information from our bank and vendors)

Please return completed credit application and include resale/tax exemption certificate to accounting for
approval. Please email to arinfo@jamericablanks.com or fax to 517-223-8374. We appreciate your
business and look forward to working with you! Thank you

J. America Wholesale Blanks 445 Van Riper Rd, Fowlerville, MI 48836 Ph: (517)521-1105, Fx: (517)223-8374
J. America Wholesale Blanks 445 Van Riper Rd, Fowlerville, MI 48836 Ph: (517)521-1105, Fx: (517)223-8374