John Henry Foster Company

Phone:

314-427-0600

4700 LeBourget Drive

Fax:

314-593-1294

P.O. Box 5820

Website:

www.jhf.com

St. Louis, Missouri  63134-0820

 

E-Mail:

sales@jhf.com

Web Credit Application

PLEASE PRINT OR TYPE

 

COMPANY NAME

STREET ADDRESS

P.O. BOX

CITY, STATE, ZIP CODE

TYPE OF BUSINESS

PHONE NUMBER

DATE BUSINESS EST.

FAX NUMBER

YEARS AT PRESENT ADDRESS


PRINCIPALS

NAME

 

1.

TITLE

HOME ADDRESS

 

 

2.

 

 

 

 

3.

 

 


BANK REFERENCE

BANK NAME

 

 

ADDRESS

CITY, STATE, ZIP CODE

PHONE NUMBER


TRADE REFERENCES

To expedite processing, please include the fax number for each trade reference listed.

NAME

ADDRESS

PHONE #

1.

 

FAX #

 

 

PHONE #

2.

 

FAX #

 

 

PHONE #

3.

 

FAX #

 

PROPRIETOR AUTHORIZATION:  (Does not apply to corporations) By signing this Application, I authorize the John Henry Foster Company or its

agent to investigate my personal credit and financial records including my banking records.  As part of such investigation, I authorize the

John Henry Foster Company to request and obtain consumer credit reports on me in connection with the opening, monitoring, renewal and extension of

this and other accounts with the John Henry Foster Company.  If I request, you will tell me whether my consumer credit report was requested

and, if so, the name and address of the consumer credit reporting agency that furnished me the report.

 

In the event that this account should be placed for collection, I (we) understand that I (we) am responsible for all collection fees incurred.

 

 

Name (printed): ________________________________________          Authorized Signature: ____________________________________________

 

 

Date: _____________________________________________           Title: _____________________________________________________________

 

 

I (we) hereby certify that the above statements are true.  I (we) understand that this application shall remain the property of

John Henry Foster Company of St. Louis, Inc.  Any person who knowingly makes a false statement or misrepresentation in this application shall be

subject to rejection of credit or cancellation of account.

 

Name of John Henry Foster representative who issued this form:. WEBSITE

 

Order pending?                        ⃞ YES            ⃞ NO                  If yes, dollar value of order: $_____________________________

 

Credit limit requested: $  _____________________________