WBC Personal Account Application

PERSONAL ACCOUNT APPLICATION
Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone
EMAIL
example@example.com
Social Security #
Date Of Birth

MonthDayYear
Date
Driver's License #
Occupation
Current Employer
Years with Current Employer
Employer's Address
Spouse's Name
Spouse's Social Security #
Spouse's Date Of Birth

MonthDayYear
Date
BANK REFERENCE
Bank
Branch
Account #
Contact Person
PHONE
EMAIL
example@example.com
APPLICANT'S SIGNATURE(S)
The undersigned Applicant(s) hereby provides the above information for the purpose of obtaining credit and authorizes the obtaining of information concerning any statement made herein and the investigation of credit worthiness of the Applicant(s Consumer reports may be requested in connection with the processing of this application and subsequently pursuant to the Fair Credit Reporting Act. Upon request. J. Wright Building Center, Inc. ("Wright Building Center") will inform Applicant(s) of the names and addresses of any consumer reporting ogencies that have provided such reports, Applicant(s) agrees to be bound by the terms and conditions set forth in the following credit policy: All accounts are billed monthly, and payment is due in full by the 15th of the month following a credit purchase. By signing this credit agreement. Applicant(s) accepts responsibility and agrees to pay for every invoice that is charged to the account. The Applicant(s) will be jointly and severally liable for all credits advanced as a result of all charges against the account [including. but not limited to. unauthorized use of the account) and that the charges were the duly authorized act of and are binding upon the applicant(s Any and all such requests and agreements shall remain in full force and effect until written notice of the amendment, rescission or termination thereof has been delivered to and receipted for by Wright Building Center. A 1.5% per month late charge is added to delinquent accounts. Accounts are considered delinquent on the 11th day of the month following a credit purchase if payment is not received. In the event an account is delinquent, additional charges will be added for costs. expenses. and attorneys and other fees paid or incurred or adjudged by a court, as a consequence of nonpayment including al reasonable cost of collection. including costs and expenses of attorneys fees towardsthe collection and enforcement of the obligation to pay, whether suit is filed or not. If credit is required for a period of time exceeding 30 days. arrangements must be made with a bank or other financing agency in advance. Past due balances paid by credit card will be subject to surcharge fee's.
Name
Date

MonthDayYear
Date
Signature

Clear
Name
DATE

MonthDayYear
Date
SIGNATURE

Clear
Hold tight, just a few more questions

Do you have any additional delivery addresses that you would like set up?
Job Name: blanks Delivery Address: Street Address Address Line 2 City State Zip
Job Name: blanks Delivery Address: Street Address Address Line 2 City State Zip
Job Name: blanks Delivery Address: Street Address Address Line 2 City State Zip
Job Name: blanks Delivery Address: Street Address Address Line 2 City State Zip
Authorized Users

List any individuals that are allowed to charge on your account:
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Invoices

How would you like to receive your invoices?
Type a question

Printed - A printed invoice will be sent with each deliveryTime of Purchase Email - An Email will be sent out when the order is invoiced. This is great for those who like to keep track of their team or contractor's purchases in real time.Nightly Email - This is good for those who have 5 or more transactions a day and do not want to be bombarded with several emails throughout the day. With this option, all invoices from the day are emailed each night.Account Access - Don't need emails or printed copies? No problem. You can access you WBC Account 24/7 for invoices and so much more.
Requested User Name for online account access:
Monthly Statements
How would you like to receive your monthly statement?

MailedEmailed
Your statement balance is due in full on the 15th of each month. Statements are sent out Monthly. They are processed on the 1st of each month. When the first falls on a weekend or holiday, statements will be processed on the next business day. Please note that your monthly statement does not include a break down of each invoice.
Would you like to have copies of invoices included with your statement?

YesNo
How would you like to be notified once your account is set up?

PhoneEmailText
Should be Empty:

Now create your own Jotform - It's free!Create your own Jotform

PERSONAL ACCOUNT APPLICATION

BANK REFERENCE

APPLICANT'S SIGNATURE(S)

Hold tight, just a few more questions

Authorized Users

Invoices

Monthly Statements