Credit Application

  • Credit Application
Please fill out completely to prevent any delay in shipment.

    CONTACT INFORMATION

    Full Name
    Title
    Phone
    Email

    BUSINESS INFORMATION

    Business Name
    Business Type
    Website (if applicable)
    Phone
    Registered Business Address
    City, State, and Zip Code
    Bill to Address
    City, State, and Zip Code
    EIN or TAX ID#
    DUNS #
    Accounting Email
    Date Business Commenced
    Do you have a Sales Tax Resale, Exemption Certificate, or Direct Sales Tax Permit?
    If you answered Yes, please upload a PDF copy here

    BANK INFORMATION

    Bank Name
    Bank City, State, and Zip Code
    Type of Account
    Account Number

    BUSINESS/TRADE REFERENCES (*NOTE: PLEASE DO NOT USE TESSCO AS THEY WILL NOT PROVIDE A REFERENCE*)

    REFERENCE #1
    Company Name
    Email
    Phone
    Fax (optional)
    Address
    City, State, and Zip Code
    REFERENCE #2
    Company Name
    Email
    Phone
    Fax (optional)
    Address
    City, State, and Zip Code
    REFERENCE #3
    Company Name
    Email
    Phone
    Fax (optional)
    Address
    City, State, and Zip Code

    Today's Date

    Note: By submitting this application, you authorize JPS Interoperability Solutions, Inc. to make inquiries into the banking/business/trade references that you have supplied.

    GET THE LATEST JPS UPDATES IN YOUR INBOX

    News, product information, webinars, and more!