JX | JX Parts and Service Credit Application

JX Parts & Service App (1)

Credit Application for Parts & Service

By marking this box, I consent to do business electronically with JX
Business Type*
Company Information
Full Legal Name of Business*
DBA
Billing Address*
Street Address Address Line 2 City State ZIP Code
Shipping Address
Street Address Address Line 2 City State ZIP Code
Phone*
Cell
Fax
Email for Statements*
Email for Invoices
Company Principals/Registered Agents*
Tax Exempt
If tax exempt, please attach proper form in .pdf format:
Accepted file types: pdf, Max. file size: 200 MB.
A/P Phone
Contact Name*
Purchase Orders Required?*
Purchase Order Format*
Estimated Monthly Credit Requirements*
Check for ACH/Wire?*
Do you have any additional documents you would like to submit?
Drop files here or

Accepted file types: doc, docx, pdf, Max. file size: 200 MB.
Guarantor Information
Name(s) of Guarantor(s)*
First Last First Last
Billing Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Fax
Cell
Email*
Email
DOB*
MM slash DD slash YYYY
SSN*
The above information is given for the purpose of inducing JX Enterprises, Inc to provide rentals, parts, and services, and is warranted to be true, accurate, and complete. JX Enterprises, Inc may reject any application in its sole discretion. We hereby authorize all persons or entities named above to release complete financial information regarding the applicant or the guarantor to JX Enterprises, Inc or its authorized representative, in the even an application is accepted and an account is opened, it will be subject to the JX Enterprises, Inc customer account terms and conditions attached hereto.
Signature*

Please provide your authorized personal signature here
Today's Date*
MM slash DD slash YYYY
*Individual Personal Guarantee*
In consideration of your sales of parts, rentals, and/or provision of services, I personally guarantee and bind myself to pay you on demand any sum which the "business" named above fails to pay. It is understood that I am to pay you on demand, and that this guaranty is a continuing and irrevocable guarantee for such indebtedness, and is a guarantee of collection and not of payment, and that by my signature below I hereby waive notice of default, non-payment, and notice thereof and consent to any modification or renewal of this agreement hereby granted.
Signature
Address
Street Address Address Line 2 City State ZIP Code
DOB
MM slash DD slash YYYY
SSN
Signature

Please provide your authorized personal signature here
Address
Street Address Address Line 2 City State ZIP Code
DOB
MM slash DD slash YYYY
SSN
Are you interested in receiving updates on any of the following?
- New/Used Truck Specials
- Lease/Rental Specials
- Parts/Service Specials
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JX Parts & Service App (1)

Company Information

Guarantor Information

*Individual Personal Guarantee*

Individual Personal Guarantee