Application for Credit

J & E Supply & Fastener Co., Inc. · 1903 SE 59th St, Oklahoma City, OK 73129 · Phone (405) 670-1234 · Fax (405) 672-7756

Your business

Legal business name *

DBA / trade name optional

Business structure *

Years in business

Federal Tax ID / EIN optional

Business phone *

Fax optional

Email *

Billing & shipping

Billing street address *

City *

State *

ZIP *

Shipping address is the same as billing

Banking reference

Your primary business bank. We use this to verify standing — it is never shared.

Bank name

Bank phone

Account number

Trade references

Suppliers you buy from on terms. At least two are required — and a phone or email we can actually reach is what makes a reference useful.

CompanyPhoneEmail (or fax)

Tax status & purchasing

How are your purchases taxed? *

Taxable Tax exempt — resale Tax exempt — manufacturer

Do your invoices require a PO number?

Yes, always No

Authorized purchasers

Who may place orders on this account. You can add or change these later.

Authorization & signature

I certify that the information provided is true and complete, and that I am authorized to submit this application on behalf of the business named above. Our firm is financially able to meet the commitments we make to J & E Supply & Fastener Co., and we agree to pay invoices according to the payment terms established for our account. I authorize J & E Supply to verify the information above, including the bank and trade references provided.

I have read and agree to the statement above, and I intend my typed name below to be my electronic signature.

Signature (type your full name) *

Title *

Date

Thank you — your application is in. Our credit team will review it and follow up. Questions in the meantime? Call either counter.

Submitting this application doesn’t open an account by itself — our credit team reviews every application and may follow up for a signed copy or additional detail before terms are set up. Prefer to talk it through first? Call us and we’ll walk you through it.

Return your completed form: fax to (405) 672-7756, email to itsupport@jandesupply.com, or bring it to either counter — Oklahoma City (405) 670-1234 · Duncan (580) 255-2582.

What happens next

1You submit this application securely.
2Our credit team verifies your bank & trade references.
3We set up your account and send you your account number.

Rather print & send it in?

Some folks would rather do it on paper — that’s fine. Print or save a blank copy, fill it out, and fax, email, or drop it by either counter.

Before you start

Have handy: your billing address, business bank info, at least two trade references (name + phone or email), and your resale/exemption certificate if you’re tax-exempt.

Your bank and tax details are transmitted over a secure connection and reviewed only by our credit staff. We never sell or share your information.

Rather apply by phone?

Oklahoma City405-670-1234 Duncan580-255-2582

Apply for a Credit Account

Application for Credit

Your business

Billing & shipping

Banking reference

Trade references

Tax status & purchasing

Authorized purchasers

Authorization & signature