1. Print this form
2. Complete and sign credit application
3. Fax completed application to 610-667-3522 Questions? Call 1-800-220-1233
DEALER INTERNET CREDIT APPLICATION

Company Name: ____________________________________
Street Address: ____________________________________
Mailing Address: ____________________________________
City & State: ________________________ Zip ___________
Date ________________
Phone: ______________
Fax: ________________
E-mail: ______________
Established: __________
This business is a   _____ Sole Proprietorship       _____ Partnership       _____ Corporation
Please supply member#   JBT_______________ ASI_______________ D&B____________
THE OWNER, OR, IF CORPORATION, THE OFFICER IS:
Name                                                         Title               Address               Telephone
_________________________________________________________________________
TRADE SUPPLIER REFERENCES:
Supplier #1
Name____________________________________ Phone_______________
Address__________________________________ Fax_________________
City/State_________________________________ Zip__________________
Supplier #2
Name____________________________________ Phone_______________
Address__________________________________ Fax_________________
City/State_________________________________ Zip__________________
Supplier #3
Name____________________________________ Phone_______________
Address__________________________________ Fax_________________
City/State_________________________________ Zip__________________
CREDIT INFORMATION

THE INFORMATION SUBMITTED ABOVE IS COMPLETE, ACCURATE AND TRUE TO THE BEST OF MY KNOWLEDGE.

Applicant's Signature __________________________________________ Title ________________

PROVIDING FAX NUMBER & EMAIL WILL EXPEDITE THE APPROVAL PROCESS. THANK YOU!
If you have any questions regarding this application, please call 1-800-220-1233.

1. The MINIMUM initial order to acquire dealership is $1500.
2. Fax completed form to 610-667-3522 Questions? Call 1-800-220-1233
NEW DEALER INTERNET ORDER
SHIP VIA:   ____ UPS    ____ BL    ____ GRD    ____ RD    ____ PP    ____ FEDEX
BILL TO:
SHIP TO:
NAME
NAME
STREET
STREET
CITY, STATE, ZIP
CITY, STATE, ZIP
ATTN:
ATTN:
DATE
APPROVED BY
ORDER TAKEN BY
CREDIT OK
SALESMAN
   INTERNET
SHIP FOB
Bala Cynwyd
ADV.ALLOW.
P.O. NUMBER
PHONE NUMBER
FAX NUMBER
EMAIL
TERMS
QUANTITY
STYLE
DESCRIPTION & COMMENTS
COST
EXTENDED COST
ORDER ACKNOWLEDGED BY

IF CREDIT CARD:   ____VISA   ____MC   ____AMEX
SPECIAL INSTRUCTIONS

CC# _________________________________________


EXP DATE ____________________________________

    USA HEADQUARTERS - Bala Cynwyd, PA

SWITZERLAND - La Chaux de Fonds