Credit Application – Jack Rich Lubricants

Main Office:

Jack Rich Lubricants, Inc.

617 Altamont Blvd.
Frackville, PA 17931

570-622-3000

Warehouse:

230 Jackson St.
Port Carbon, PA 17965

Jack Rich Lubricants Keep You Moving

Office Hours:

Monday – Friday: 8:00 am – 4:00 pm
Saturday & Sunday: Closed

Sales Tax Exemption Form (PDF)

* Please Complete The Credit Application Form Below
Completion and submission of the information is not an acceptance of extending credit nor binding on Jack Rich to provide credit. A Jack Rich representative will contact you with respect to your application.
Contact Jack Rich Lubricants with questions.

Commercial Credit Application
Company Name(Required)
President(Required)
First Last
Delivery Address(Required)
Street Address Address Line 2 City State ZIP Code
Same as Delivery Address
- Same as Delivery Address
Mailing Address(Required)
Street Address Address Line 2 City State ZIP Code
Business Phone(Required)
Business Fax
Email Address For Accounts Payable(Required)
Enter Email Confirm Email
Business Website
Business Federal ID (EIN)(Required)
Business County
How Long In Business (in years)(Required)
Please enter a number from 0 to 100.
Have you ever dealt with our company before?(Required)
What is your anticipated Monthly Volume with our company (in dollars)?(Required)
Bankruptcy(Required)
Has any company officer or has the company ever filed for bankruptcy?
- Yes
- No
Financial Information
Primary Bank(Required)
Account No(Required)
Bank Phone(Required)
Bank Fax(Required)
Bank Address(Required)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Vendor References
Vendor Reference #1(Required)
Business Name Address Phone Fax Account Number
Vendor Reference #2(Required)
Business Name Address Phone Fax Account Number
Vendor Reference #3(Required)
Business Name Address Phone Fax Account Number
Payment can be made by credit card, however, there will be a 2% processing fee assessed.
Finance charges are accrued on accounts not paid within terms of account. The finance charge is computed by a periodic rate of 1 1/2% per month (18% per year) on unpaid balance. Any and all collection agency fees, court costs, attorney and miscellaneous fees will be claimed should your account be placed for collection for any reason.
Consent(Required)
I authorize Jack Rich, Inc. to make any credit inquiries it deems necessary.
I authorize the passing on of financial information to Jack Rich Inc. in the attempt to receive credit and in getting an account established. I am an authorized representative for said company.
Your Name(Required)
First Last
Title(Required)
Email(Required)
Enter Email Confirm Email
Phone(Required)
Signature(Required)
eNewsletter, Promos & Notifications
- Yes - Sign Me Up!
Email
This field is for validation purposes and should be left unchanged.

Credit Application – Jack Rich Lubricants

Main Office:

Jack Rich Lubricants, Inc.

Warehouse:

Jack Rich Lubricants Keep You Moving

Office Hours:

Commercial Credit Application

Financial Information

Vendor References

Payment can be made by credit card, however, there will be a 2% processing fee assessed.