Raymond Johns Company, Inc.
          Email:RayJohnCo@raymondjohns.com


APPLICATION FOR CREDIT
Fill out, print and mail or fax the application.
(Failure to provide requested information may result in processing delays.)

Company Name
 Telephone Number
Street Address
 City
 State
 Zip
Billing Address
(If different than above)
 City
 State
 Zip
Name of Parent Company
 Telephone Number
Type of Business:
    Industrial
     Hotels/Motels     Commercial     Church
     Restaurants
    Health Care     Contract Cleaners     Schools     Other How long in Business?
Credit Limit Requested
   $200
   $500
   $1,200
   $2,500
   $3,500
   $4,500
Purchase Order Required?      Yes      No Tax Exempt       Yes       No
(If yes, attach a Tax Exemption Certificate)

ACCOUNTING INFORMATION:
Do you pay from
       Statement (* See Terms)       Invoice (*See Terms)		 Accounts Payable Person
Fax Number
 Local Manager's
Name

CORPORATION INFORMATION ONLY:
State of Incorporation Date of Incorporation
President
 Address
 City
 State
 Zip
Secretary
 Address
 City
 State
 Zip
Treasurer
 Address
 City
 State
 Zip

PARTNERSHIP INFORMATION ONLY:
(Must Include Social Security Number)
Owner's Name
 Address
City
 State
 Zip
Social Security Number
(Required)
 D.O.B.
 Phone
Owner's Name
 Address
City
 State
 Zip
Social Security Number
(Required)
 D.O.B.
 Phone

TRADE REFERENCES:
(Please Include Fax Numbers)
(Give only names of those from whom you buy on Open Account.)
Name
 Address
City
 State
 Zip
 Phone
 Fax
Name
 Address
City
 State
 Zip
 Phone
 Fax
Name
 Address
City
 State
 Zip
 Phone
 Fax

BANK REFERENCE:
Bank Name
 Address
City
 State
 Zip
 Phone
 Acct. Rep.

*TERMS:

Statement Terms - Due upon Receipt       Invoice Terms - Net 30 days

I/We agree to pay a service charge of 1.5% per month, (18% per annum) and to pay all reasonable attorney's fees and court costs for the collection of any delinquent balance. A $25.00 service charge will be assessed against applicant's accounts upon receipt of any returned check by your bank.

All the preceding statements are true to the best of my knowledge.

Signature Title
Please Print Name

FOR CREDIT DEPARTMENT USE:
Salesman Name
 Salesman Number
  Credit Approved       Maximum Credit Limit $         Credit Declined
Signed
 Title
 Date


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