{"id":46755,"date":"2026-11-09T11:46:37","date_gmt":"2026-11-09T16:46:37","guid":{"rendered":"https:\/\/jcbakker.com\/new\/?page_id=46755"},"modified":"2026-11-11T11:24:38","modified_gmt":"2026-11-11T16:24:38","slug":"wholesale-application","status":"publish","type":"page","link":"https:\/\/jcbakker.com\/new\/wholesale-application\/","title":{"rendered":"Wholesale Application Form"},"content":{"rendered":"<div class=\"wpb-content-wrapper\" id=\"wpb-content-root\"><p>[vc_row][vc_column][vc_empty_space height=&#8221;48px&#8221; woodmart_hide_large=&#8221;0&#8243; woodmart_hide_medium=&#8221;0&#8243; woodmart_hide_small=&#8221;0&#8243;][vc_column_text woodmart_inline=&#8221;no&#8221; text_larger=&#8221;no&#8221;]<\/p>\n<p style=\"text-align: center;\">Print and send us the PDF version, or fill out the fields below.<\/p>\n<p>[\/vc_column_text]<div id=\"wd-6af34d1c4dc5a\" class=\" wd-rs-6af34d1c4dc5a  wd-button-wrapper text-center\"><a href=\"https:\/\/jcbakker.com\/new\/wp-content\/uploads\/2026\/11\/CreditApp_Fillable-1.pdf\" title=\"\" class=\"btn btn-color-black btn-style-default btn-shape-round btn-size-large btn-icon-pos-right\">Fillable &amp; Printable PDF<span class=\"wd-btn-icon\"><span class=\"wd-icon fa fa-solid fa-file-pdf\"><\/span><\/span><\/a><\/div>[vc_empty_space height=&#8221;48px&#8221; woodmart_hide_large=&#8221;0&#8243; woodmart_hide_medium=&#8221;0&#8243; woodmart_hide_small=&#8221;0&#8243;]<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_3' ><div id='gf_3' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_3' id='gform_3'  action='\/new\/wp-json\/wp\/v2\/pages\/46755#gf_3' data-formid='3' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_3' class='gform_fields top_label form_sublabel_above description_above validation_above' data-column-layout='fixed'><div id=\"field_3_35\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_above gfield--has-description field_description_above field_validation_above gfield_visibility_visible\"><label id='gfield_label_3_35' class='gfield_label gform-field-label' for='input_3_35'><span class='gform-field-label__text'>Comments<\/span><\/label><div class='gfield_description' id='gfield_description_3_35'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_35' id='input_3_35' type='text' value='' autocomplete='new-password'\/><\/div><\/div><div id=\"field_3_8\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"d181751c\" data-field-span=\"6\"><label id='gfield_label_3_8' class='gfield_label gform-field-label' for='input_3_8'><span class='gform-field-label__text'>Registered or Legal Name of Business<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_3_8' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_33\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"d181751c\" data-field-span=\"6\"><label id='gfield_label_3_33' class='gfield_label gform-field-label' for='input_3_33'><span class='gform-field-label__text'>USA Federal Tad ID or Canadian HST\/PST No.<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_3_33' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_16\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"fe86e573\" data-field-span=\"6\"><label id='gfield_label_3_16' class='gfield_label gform-field-label' for='input_3_16'><span class='gform-field-label__text'>Age of business<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_3_16' type='text' value='' class='large'    placeholder='Months or years'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_17\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"fe86e573\" data-field-span=\"6\"><label id='gfield_label_3_17' class='gfield_label gform-field-label' for='input_3_17'><span class='gform-field-label__text'>Length of time at current address<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_3_17' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_3_22\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible gfield--choice-align-horizontal\" data-group-id=\"58d0a1f3\" data-field-span=\"6\"><legend id='gfield_label_3_22' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Type of Business<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_22'>\n\t\t\t<div class='gchoice gchoice_3_22_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Proprietorship'  id='choice_3_22_0' onchange='gformToggleRadioOther( this )'  aria-labelledby=\"label_3_22_0 gfield_label_3_22\"   \/>\n\t\t\t\t\t<label for='choice_3_22_0' id='label_3_22_0' class='gform-field-label gform-field-label--type-inline'>Proprietorship<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_22_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Partnership'  id='choice_3_22_1' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_3_22_1' id='label_3_22_1' class='gform-field-label gform-field-label--type-inline'>Partnership<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_22_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Incorporated'  id='choice_3_22_2' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_3_22_2' id='label_3_22_2' class='gform-field-label gform-field-label--type-inline'>Incorporated<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_25\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible gfield--choice-align-horizontal\" data-group-id=\"58d0a1f3\" data-field-span=\"6\"><legend id='gfield_label_3_25' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Status of Property<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_25'>\n\t\t\t<div class='gchoice gchoice_3_25_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Owned'  id='choice_3_25_0' onchange='gformToggleRadioOther( this )'  aria-labelledby=\"label_3_25_0 gfield_label_3_25\"   \/>\n\t\t\t\t\t<label for='choice_3_25_0' id='label_3_25_0' class='gform-field-label gform-field-label--type-inline'>Owned<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_25_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Leased'  id='choice_3_25_1' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_3_25_1' id='label_3_25_1' class='gform-field-label gform-field-label--type-inline'>Leased<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_5\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"ce2e97ea\" data-field-span=\"12\"><legend id='gfield_label_3_5' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Business Mailing Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_3_5' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_3_5_1_container' >\n                                        <label for='input_3_5_1' id='input_3_5_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_5.1' id='input_3_5_1' value=''    aria-required='true'    aria-labelledby=\"input_3_5_1_label gfield_label_3_5\"\/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_3_5_2_container' >\n                                        <label for='input_3_5_2' id='input_3_5_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_5.2' id='input_3_5_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_3_5_3_container' >\n                                    <label for='input_3_5_3' id='input_3_5_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_5.3' id='input_3_5_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_3_5_4_container' >\n                                        <label for='input_3_5_4' id='input_3_5_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                        <input type='text' name='input_5.4' id='input_3_5_4' value=''      aria-required='true'    \/>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_3_5_5_container' >\n                                    <label for='input_3_5_5' id='input_3_5_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                    <input type='text' name='input_5.5' id='input_3_5_5' value=''    aria-required='true'    \/>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_3_5_6_container' >\n                                        <label for='input_3_5_6' id='input_3_5_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                        <select name='input_5.6' id='input_3_5_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AX' >\u00c5land Islands<\/option><option value='AL' >Albania<\/option><option value='DZ' >Algeria<\/option><option value='AS' >American Samoa<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua and Barbuda<\/option><option value='AR' >Argentina<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australia<\/option><option value='AT' >Austria<\/option><option value='AZ' >Azerbaijan<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BY' >Belarus<\/option><option value='BE' >Belgium<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius and Saba<\/option><option value='BA' >Bosnia and Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet Island<\/option><option value='BR' >Brazil<\/option><option value='IO' >British Indian Ocean Territory<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgaria<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='CV' >Cabo Verde<\/option><option value='KH' >Cambodia<\/option><option value='CM' >Cameroon<\/option><option value='CA' selected='selected'>Canada<\/option><option value='KY' >Cayman Islands<\/option><option value='CF' >Central African Republic<\/option><option value='TD' >Chad<\/option><option value='CL' >Chile<\/option><option value='CN' >China<\/option><option value='CX' >Christmas Island<\/option><option value='CC' >Cocos Islands<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoros<\/option><option value='CG' >Congo<\/option><option value='CD' >Congo, Democratic Republic of the<\/option><option value='CK' >Cook Islands<\/option><option value='CR' >Costa Rica<\/option><option value='CI' >C\u00f4te d&#039;Ivoire<\/option><option value='HR' >Croatia<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cyprus<\/option><option value='CZ' >Czechia<\/option><option value='DK' >Denmark<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominican Republic<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypt<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatorial Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estonia<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Ethiopia<\/option><option value='FK' >Falkland Islands<\/option><option value='FO' >Faroe Islands<\/option><option value='FJ' >Fiji<\/option><option value='FI' >Finland<\/option><option value='FR' >France<\/option><option value='GF' >French Guiana<\/option><option value='PF' >French Polynesia<\/option><option value='TF' >French Southern Territories<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgia<\/option><option value='DE' >Germany<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GR' >Greece<\/option><option value='GL' >Greenland<\/option><option value='GD' >Grenada<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard Island and McDonald Islands<\/option><option value='VA' >Holy See<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hungary<\/option><option value='IS' >Iceland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesia<\/option><option value='IR' >Iran<\/option><option value='IQ' >Iraq<\/option><option value='IE' >Ireland<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Israel<\/option><option value='IT' >Italy<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordan<\/option><option value='KZ' >Kazakhstan<\/option><option value='KE' >Kenya<\/option><option value='KI' >Kiribati<\/option><option value='KP' >Korea, Democratic People&#039;s Republic of<\/option><option value='KR' >Korea, Republic of<\/option><option value='KW' >Kuwait<\/option><option value='KG' >Kyrgyzstan<\/option><option value='LA' >Lao People&#039;s Democratic Republic<\/option><option value='LV' >Latvia<\/option><option value='LB' >Lebanon<\/option><option value='LS' >Lesotho<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libya<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Lithuania<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao<\/option><option value='MG' >Madagascar<\/option><option value='MW' >Malawi<\/option><option value='MY' >Malaysia<\/option><option value='MV' >Maldives<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MH' >Marshall Islands<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritania<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldova<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolia<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MA' >Morocco<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NP' >Nepal<\/option><option value='NL' >Netherlands<\/option><option value='NC' >New Caledonia<\/option><option value='NZ' >New Zealand<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='NF' >Norfolk Island<\/option><option value='MK' >North Macedonia<\/option><option value='MP' >Northern Mariana Islands<\/option><option value='NO' >Norway<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestine, State of<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua New Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PH' >Philippines<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Poland<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Romania<\/option><option value='RU' >Russian Federation<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='KN' >Saint Kitts and Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='MF' >Saint Martin<\/option><option value='PM' >Saint Pierre and Miquelon<\/option><option value='VC' >Saint Vincent and the Grenadines<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome and Principe<\/option><option value='SA' >Saudi Arabia<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seychelles<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >Slovakia<\/option><option value='SI' >Slovenia<\/option><option value='SB' >Solomon Islands<\/option><option value='SO' >Somalia<\/option><option value='ZA' >South Africa<\/option><option value='GS' >South Georgia and the South Sandwich Islands<\/option><option value='SS' >South Sudan<\/option><option value='ES' >Spain<\/option><option value='LK' >Sri Lanka<\/option><option value='SD' >Sudan<\/option><option value='SR' >Suriname<\/option><option value='SJ' >Svalbard and Jan Mayen<\/option><option value='SE' >Sweden<\/option><option value='CH' >Switzerland<\/option><option value='SY' >Syria Arab Republic<\/option><option value='TW' >Taiwan<\/option><option value='TJ' >Tajikistan<\/option><option value='TZ' >Tanzania, the United Republic of<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad and Tobago<\/option><option value='TN' >Tunisia<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks and Caicos Islands<\/option><option value='TV' >Tuvalu<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukraine<\/option><option value='AE' >United Arab Emirates<\/option><option value='GB' >United Kingdom<\/option><option value='US' >United States<\/option><option value='UY' >Uruguay<\/option><option value='UM' >US Minor Outlying Islands<\/option><option value='UZ' >Uzbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Viet Nam<\/option><option value='VG' >Virgin Islands, British<\/option><option value='VI' >Virgin Islands, U.S.<\/option><option value='WF' >Wallis and Futuna<\/option><option value='EH' >Western Sahara<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option> <\/select>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_3_10\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"718cee0c\" data-field-span=\"4\"><label id='gfield_label_3_10' class='gfield_label gform-field-label' for='input_3_10'><span class='gform-field-label__text'>Business Phone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_3_10' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_12\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"718cee0c\" data-field-span=\"4\"><label id='gfield_label_3_12' class='gfield_label gform-field-label' for='input_3_12'><span class='gform-field-label__text'>Business Fax<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_3_12' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_11\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-third field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"718cee0c\" data-field-span=\"4\"><label id='gfield_label_3_11' class='gfield_label gform-field-label' for='input_3_11'><span class='gform-field-label__text'>Business Email<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_11' id='input_3_11' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_3_18\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"03e26d9a\" data-field-span=\"12\"><h3 class=\"gsection_title\">Contacts<\/h3><\/div><div id=\"field_3_9\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"c55a282f\" data-field-span=\"4\"><label id='gfield_label_3_9' class='gfield_label gform-field-label' for='input_3_9'><span class='gform-field-label__text'>Main Contact Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_3_9' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_4\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"c55a282f\" data-field-span=\"4\"><label id='gfield_label_3_4' class='gfield_label gform-field-label' for='input_3_4'><span class='gform-field-label__text'>Main Contact Phone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_3_4' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_3_3\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"c55a282f\" data-field-span=\"4\"><label id='gfield_label_3_3' class='gfield_label gform-field-label' for='input_3_3'><span class='gform-field-label__text'>Main Contact Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_3' id='input_3_3' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_3_13\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"11da1d6f\" data-field-span=\"6\"><label id='gfield_label_3_13' class='gfield_label gform-field-label' for='input_3_13'><span class='gform-field-label__text'>Additional Contact: Purchasing<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_3_13' type='text' value='' class='large'    placeholder='Name + Phone or email'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_14\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"11da1d6f\" data-field-span=\"6\"><label id='gfield_label_3_14' class='gfield_label gform-field-label' for='input_3_14'><span class='gform-field-label__text'>Additional Contact: Payables<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_3_14' type='text' value='' class='large'    placeholder='Name + Phone or email'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_15\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"c83b3ab1\" data-field-span=\"12\"><label id='gfield_label_3_15' class='gfield_label gform-field-label' for='input_3_15'><span class='gform-field-label__text'>Owner(s) or Principle<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_3_15'>Include Name, Title, Address of all owners or partners.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_15' id='input_3_15' class='textarea small'  aria-describedby=\"gfield_description_3_15\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_19\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"97a2608c\" data-field-span=\"6\"><label id='gfield_label_3_19' class='gfield_label gform-field-label' for='input_3_19'><span class='gform-field-label__text'>Approximate monthly credit required (CAD)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_3_19' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_3_21\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible gfield--choice-align-horizontal\" data-group-id=\"97a2608c\" data-field-span=\"6\"><legend id='gfield_label_3_21' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Are personal guarantees available if requested?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_21'>\n\t\t\t<div class='gchoice gchoice_3_21_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Yes'  id='choice_3_21_0' onchange='gformToggleRadioOther( this )'  aria-labelledby=\"label_3_21_0 gfield_label_3_21\"   \/>\n\t\t\t\t\t<label for='choice_3_21_0' id='label_3_21_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_21_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='No'  id='choice_3_21_1' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_3_21_1' id='label_3_21_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_26\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"a1a4b58d\" data-field-span=\"12\"><h3 class=\"gsection_title\">Credit References (Trade related)<\/h3><\/div><div id=\"field_3_30\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_above gfield--has-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"35875582\" data-field-span=\"6\"><label id='gfield_label_3_30' class='gfield_label gform-field-label' for='input_3_30'><span class='gform-field-label__text'>Your Bank<\/span><\/label><div class='gfield_description' id='gfield_description_3_30'>Include bank name, account number, maximum bank credit line, bank phone complete address<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_30' id='input_3_30' class='textarea small'  aria-describedby=\"gfield_description_3_30\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_27\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_above gfield--has-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"35875582\" data-field-span=\"6\"><label id='gfield_label_3_27' class='gfield_label gform-field-label' for='input_3_27'><span class='gform-field-label__text'>Reference 1<\/span><\/label><div class='gfield_description' id='gfield_description_3_27'>Include business name, contact name, address, phone, email<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_27' id='input_3_27' class='textarea small'  aria-describedby=\"gfield_description_3_27\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_29\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_above gfield--has-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"a0f2a377\" data-field-span=\"6\"><label id='gfield_label_3_29' class='gfield_label gform-field-label' for='input_3_29'><span class='gform-field-label__text'>Reference 2<\/span><\/label><div class='gfield_description' id='gfield_description_3_29'>Include business name, contact name, address, phone, email<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_29' id='input_3_29' class='textarea small'  aria-describedby=\"gfield_description_3_29\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_28\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_above gfield--has-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"a0f2a377\" data-field-span=\"6\"><label id='gfield_label_3_28' class='gfield_label gform-field-label' for='input_3_28'><span class='gform-field-label__text'>Reference 3<\/span><\/label><div class='gfield_description' id='gfield_description_3_28'>Include business name, contact name, address, phone, email<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_28' id='input_3_28' class='textarea small'  aria-describedby=\"gfield_description_3_28\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_3_6\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_above gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"c6f0b213\" data-field-span=\"12\"><legend id='gfield_label_3_6' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Terms and Conditions<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_3_6'><div class='gfield_consent_description_text gform-theme__no-reset--children' tabindex='0'>If credit is granted as requested, it is hereby understood and agreed by the applicant that terms and conditions of sale are strictly as set out in the Wholesale Price List of J. C. Bakker and Sons Limited. I\/We hereby authorize the suppliers and bank shown to supply the above captioned company with credit and financial information as requested.<\/div><\/div><div class='ginput_container ginput_container_consent'><input name='input_6.1' id='input_3_6_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_3_6\" aria-labelledby=\"input_3_6_1_label gfield_label_3_6\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label id='input_3_6_1_label' class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_3_6_1' ><span class='gform-field-label__text'>I confirm that I have read and understood the terms outlined above.<\/span><\/label><input type='hidden' name='input_6.2' value='I confirm that I have read and understood the terms outlined above.' class='gform_hidden' \/><input type='hidden' name='input_6.3' value='2' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_3_34\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"be6ae839\" data-field-span=\"12\"><div style=\"height:48px\"><\/div><\/div><fieldset id=\"field_3_7\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"0ed0b84b\" data-field-span=\"4\"><legend id='gfield_label_3_7' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Signature<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class=\"ginput_container ginput_container_signature\"><input type='hidden' value='' name='input_7' id='input_3_7_signature_filename' class='gfield_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_3_7_Container' class='gfield_signature_container' style='height:90px; width:600px; ' ><input type='hidden' id='input_3_7_data' name='input_3_7_data' class='gfield_signature_data' \/><canvas id=\"input_3_7\" width=\"600\" height=\"90\" style=\"border-style: dotted; border-width: 3px; border-color: #757575; background-color:#FFFFFF; cursor: url(https:\/\/jcbakker.com\/new\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;\" tabindex=\"0\" aria-label=\"Signature pad\" ><\/canvas><input type='text' id='input_3_7_textinput' name='input_3_7_textinput' class='gfield_signature_text_input' style='text-indent:10px;display:none;width:600px;height:90px;border-style:dotted;border-width:3px;border-color:#757575;background-color:#FFFFFF;font-family:&quot;Snell Roundhand&quot;, &quot;Segoe Script&quot;, cursive;font-size:2em;padding:0 12px;box-sizing:border-box;color:#000000;' placeholder='Type your signature' autocomplete='off' aria-label='Type your signature' \/><style type='text\/css'>\n                #input_3_7_textinput::placeholder {\n                    font-size: 1.5rem;\n                    font-family: Arial;\n                    opacity: 0.8;\n                }\n            <\/style><\/div><div id='input_3_7_toolbar' class='gfield_signature_toolbar' dir='ltr' style='margin:5px 0;position:relative;height:35px;width:600px;max-width:100%;display:flex;align-items:center;'><div id='input_3_7_status' class='gfield_signature_status gform-visually-hidden' role='status' aria-live='polite' aria-atomic='true' style='position:absolute;width:1px;height:1px;padding:0;margin:-1px;overflow:hidden;clip:rect(0,0,0,0);white-space:nowrap;border:0;'><\/div><input type='hidden' id='input_3_7_font_select' class='gfield_signature_font_select' value='script' \/><div id='input_3_7_font_dropdown' class='gfield_signature_font_dropdown'><span class='gform-common-icon gform-common-icon--chevron-down gfield_signature_font_dropdown_icon'><\/span><button type='button' id='input_3_7_font_select_button' class='gfield_signature_font_select_button gform-theme__disable' tabindex='0' aria-haspopup='listbox' aria-expanded='false' aria-label='Font Options' style='width:100%;box-sizing:border-box;overflow:hidden;text-overflow:ellipsis;white-space:nowrap;font-family:\"Snell Roundhand\", \"Segoe Script\", cursive;color:#000000'>Your Name<\/button><ul id='input_3_7_font_select_list' class='gfield_signature_font_select_list' role='listbox' tabindex='-1' style='display:none;position:absolute;top:100%;left:0;right:0;margin:0;padding:0;list-style:none;background:#fff;border:1px solid #ccc;z-index:10;max-height:200px;overflow-y:auto;box-sizing:border-box;'><li class='gfield_signature_font_option' role='option' data-value='script' tabindex='0' style='font-family:&quot;Snell Roundhand&quot;, &quot;Segoe Script&quot;, cursive; color:#000000' aria-label='Your Name, Script style'>Your Name<\/li><li class='gfield_signature_font_option' role='option' data-value='handwritten' tabindex='0' style='font-family:&quot;Bradley Hand&quot;, &quot;Comic Sans MS&quot;, cursive; color:#000000' aria-label='Your Name, Handwritten style'>Your Name<\/li><li class='gfield_signature_font_option' role='option' data-value='print' tabindex='0' style='font-family:&quot;Noteworthy&quot;, &quot;Segoe Print&quot;, cursive; color:#000000' aria-label='Your Name, Print style'>Your Name<\/li><\/ul><\/div><div class='gfield_signature_toolbar_icons' style='margin-left:auto;display:flex;align-items:center;'><button type='button' id='input_3_7_textbutton' class='gform-common-icon gform-common-icon--text-field gfield_signature_text_button gform-theme-no-framework' tabindex='0' style='background:none;border:0;padding:0;margin:0;appearance:none;-webkit-appearance:none;cursor:pointer;' alt='Text Signature' aria-label='Text Signature'><\/button><button type='button' id='input_3_7_drawbutton' class='gform-common-icon gform-common-icon--pencil gfield_signature_draw_button gform-theme-no-framework' tabindex='0' style='display:none;background:none;border:0;padding:0;margin:0;appearance:none;-webkit-appearance:none;cursor:pointer;' alt='Draw Signature' aria-label='Draw Signature'><\/button><button type='button' id='input_3_7_resetbutton' class='gform-common-icon gform-common-icon--arrow-path gfield_signature_reset_button gform-theme-no-framework' tabindex='0' style='background:none;border:0;padding:0;margin:0;appearance:none;-webkit-appearance:none;cursor:pointer;' alt='Clear Signature' aria-label='Clear Signature'><\/button><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_3_31\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"0ed0b84b\" data-field-span=\"4\"><label id='gfield_label_3_31' class='gfield_label gform-field-label' for='input_3_31'><span class='gform-field-label__text'>Signed Name and Title<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_3_31' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_32\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-third field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\" data-group-id=\"0ed0b84b\" data-field-span=\"4\"><label id='gfield_label_3_32' class='gfield_label gform-field-label' for='input_3_32'><span class='gform-field-label__text'>Signed Date<\/span><\/label><div class='ginput_container 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aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_3' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit<\/button> <input type='hidden' name='gform_ajax' value='form_id=3&amp;title=&amp;description=&amp;tabindex=0&amp;theme=gravity-theme&amp;styles=[]&amp;hash=85714da5a76ec9615f7f417b86795a4f' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_3' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_3' id='gform_theme_3' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_3' id='gform_style_settings_3' value='[]' \/>\n            <input type='hidden' 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