JLA Equipment Distributors
   
    REGISTRATION AND CREDIT APPLICATION    
       
    Business Contact Name:                    Telephone:              
               
    Business Legal Name:                  Fax Number:            
               
    Business Trade Name:                  EIN Number:            
               
    Street & Billing Address(s):               Bank Name:            
               
     City/State/Zip:               City/St/Zip:            
               
     E-Mail Address:               Contact Name:            
               
     Website Address:               Telephone:            
                                             
       
                                             
     Is Dealer Entity a: Corporation   Partnership   Sole Proprietorship        
                                             
    State Organized In:     Date Business Started or Organized:            
                                             
       
    Please Provide Names and Home Addresses Please Provide Names, Account Numbers and    
    of Company Officers, Partners or Owners Telephone Numbers of Three Trade References    
               
     Name:           Title:     Company Name:                
               
     Home Address:              Account Number:                
               
     City/State/Zip:              Tel & Fax Nos.: T     F        
                                           
     Name:           Title:     Company Name:                
               
     Home Address:              Account Number:                
               
     City/State/Zip:              Tel & Fax Nos.: T     F        
                                           
     Name:           Title:     Company Name:                
               
     Home Address:              Account Number:                
               
     City/State/Zip:              Tel & Fax Nos.: T     F        
               
    JLA EQUIPMENT DISTRIBUTORS - CREDIT EXTENSION TERMS AND CONDITIONS    
            The undersigned represents and warrants that the above information is true and accurate, and is given to induce JLA Equipment    
       Distributors ("JLA") to extend credit to the above named dealer/company.  The undersigned hereby authorizes JLA to make such    
       credit investigation as JLA deems fit, including contacting the above named bank and trade references, and obtaining credit reports.    
            The undersigned further authorizes the above named bank, trade references and credit reporting agencies to disclose to JLA any    
       and all information concerning the credit history of the above named dealer/company/applicant.      
            Unless otherwise specifically agreed to by JLA and stated on a JLA Invoice, all JLA Invoices are due and payable within fifteen     
       ___15_ days (unless otherwise approved by JLA) after the receipt of merchandise purchased from JLA.  Any JLA Invoice not paid     
     when due will result in the immediate termination of the above named dealer/company's credit privileges with JLA.      
            The undersigned has read and agrees to all of the foregoing JLA Credit Extension Terms and Conditions.          
       
    Authorized    Title   Date      
    Signature    
       
            Personal Guarantee:  I/We individually, jointly and severally personally guarantee payment of all indebtedness incurred for     
       merchandise and services furnished by JLA Equipment Distributors including finance charges and all costs of collection including    
       attorney's fees equal to 25% of any delinquent amount.  It is understood that this guarantee shall be a continuing guarantee.    
            I/We do hereby waive notice hereof and consent to any modification or renewal of the JLA Credit Extension Terms and Conditions    
       hereby guaranteed.  Date Signed:       .      
           
    Individual     Individual        
    Guarantor SS Number   Guarantor SS Number    
       
    Please complete, sign and mail the registration/application(send original), including a copy of your business license to JLA Equipment Distributors, 990 Harbor Lake Dr., Safety Harbor, Florida  34695.