800-225-5370

Credit Application

Please complete the following form, read the disclaimer below and click Submit Application at the bottom of the screen to submit your application for credit to JENSEN Tools + Supply for approval. Note that all fields must be completed for us to be able to process your application.

Applicant

Your e-mail address:
Company Type:
D-U-N-S Number:
Tax ID:
Est. Annual Purchases:
Tax Exempt:
	If 'Yes,' please fax a copy of your tax certificate to 978-688-7532 and provide your Tax Exempt Number below.
Tax Exempt Number:
Desired Credit Limit:

Billing Address

For APO or FPO addresses, please enter APO or FPO for the city, AA, AE or AP for the state, and select United States for the country.


First Name:
Last Name:
Job Title:
Company/Agency:
Address Line 1:
Address Line 2:
City:
State/Province:
ZIP/Postal Code:
Country:
Phone Number:
Fax Number:

Contacts

President:
A/P Manager:
Purchasing Manager:
Date Organized:

Bank Address

For APO or FPO addresses, please enter APO or FPO for the city, AA, AE or AP for the state, and select United States for the country.


First Name:
Last Name:
Job Title:
Company/Agency:
Address Line 1:
Address Line 2:
City:
State/Province:
ZIP/Postal Code:
Country:
Phone Number:
Fax Number:

Trade Reference 1

For APO or FPO addresses, please enter APO or FPO for the city, AA, AE or AP for the state, and select United States for the country.


First Name:
Last Name:
Job Title:
Company/Agency:
Address Line 1:
Address Line 2:
City:
State/Province:
ZIP/Postal Code:
Country:
Phone Number:
Fax Number:

Trade Reference 2

For APO or FPO addresses, please enter APO or FPO for the city, AA, AE or AP for the state, and select United States for the country.


First Name:
Last Name:
Job Title:
Company/Agency:
Address Line 1:
Address Line 2:
City:
State/Province:
ZIP/Postal Code:
Country:
Phone Number:
Fax Number:

Trade Reference 3

For APO or FPO addresses, please enter APO or FPO for the city, AA, AE or AP for the state, and select United States for the country.


First Name:
Last Name:
Job Title:
Company/Agency:
Address Line 1:
Address Line 2:
City:
State/Province:
ZIP/Postal Code:
Country:
Phone Number:
Fax Number:

Disclaimer

By submitting this form, you hereby represent that you are authorized to submit this application on the behalf of the customer listed above, and the information is for the purpose of obtaining credit and is warranted to be true. You also hereby authorize JENSEN Tools + Supply, Inc. to investigate the references listed above. It is agreed and understood that all necessary collection and legal expenses may be charged to the debtor in the event of default or failure to pay for goods sold and delivered. You further represent that the above customer applying for credit has the financial ability and willingness to pay all invoices within established terms.