EAI-JR286, Inc. – CUSTOMER SETUP FORM & CREDIT APPLICATION (PRINTABLE) Business InformationApplicant Legal Business Name*Applicant DBA (If Applicable)Tax ID/Registration #*DUNS # (If Applicable)Entity Type*Mth/Yr Business Opened*State of Incorporation*Nike Account Number if Applicable*Sales Rep Name*Contact InformationBilling Contact Name*Billing Contact Phone*Billing Contact Email* Buyer Same as Billing Contact Buyer Contact Name*Buyer Contact Phone*Buyer Contact Email* Billing Address Line 1*Billing Address Line 2City*State*Zip Code*Country* Shipping Address Same as Billing Address Shipping Address Line 1*Shipping Address Line 2City*State*Zip Code*Country*Shipping and TermsShipping Terms*If Collect, Carrier Collect #Preferred Shipping MethodRouting or Other MethodApplicant Sells Via Ecommerce?*YesNoDoes Applicant have an account with Wells Fargo Factor?*YesNoIf yes, Applicant Wells Fargo Factor Acct #Credit Line Amount Requested (USD)*Owners/OfficersName*Title*Phone*Email* NameTitlePhoneEmail NameTitlePhoneEmail Bank ReferenceBank Name*Bank Contact Name*Bank Contact Phone*Bank Contact Email* Bank Address Line 1*Bank Address Line 2City*State*Zip Code*Country*Trade ReferencesTrade Reference 1 Business Name*Trade Reference 1 Contact Name*Trade Reference 1 Contact Phone*Trade Reference 1 Email* Trade Reference 1 Address Line 1*Trade Reference 1 Address Line 2City*State*Zip Code*Country*Trade Reference 2 Business Name*Trade Reference 2 Contact Name*Trade Reference 2 Contact Phone*Trade Reference 2 Email* Trade Reference 2 Address Line 1*Trade Reference 2 Address Line 2City*State*Zip Code*Country*EAI-JR286, Inc. is factored by Wells Fargo Capital Services, Inc. (WF), - 100 Park Ave, 3rd Floor, New York, NY 10017, Fax#: 212.703.3597 or 212.703.3590 - who services our customer credit requirements. In order for WF to start the process of extending credit to your company, the information requested above is required. WF reserves the right to ask for additional information. All information requested will be used for your benefit and to help make a sound credit decision of your company. Please complete the information above and return it promptly to our sales representative. Our acceptance of the credit application does not constitute the opening of an account. This application is subject to credit and sales approval. All information provided in this application and any additional information provided is true and complete. Upon accepting this application and establishment of a customer account number, I confirm the acceptance of EAI-JR286’s terms and conditions. I understand that these terms and conditions are in effect for any and all orders placed.Legal Representative SignatureFull Name*Title*Date*Confirmation*Yes, I ConfirmBy checking this box, I confirm that all information provided in this application and any additional information provided is true and complete. Upon accepting this application and establishment of a customer account number, I confirm the acceptance of EAI-JR286, Inc.’s terms and conditions. I understand that these terms and conditions are in effect for any and all orders placed.Signature* * Indicates a required field.