Peterbilt of Sioux Falls
CREDIT APPLICATION

Name
Address
City
SSN or Federal ID#
Credit Limit Requested
Are purchase orders required
Authorized to make purchases
Accounts payable contact
Purchases for resale
If YES please fill out resale Cert. Form


BANK REFERENCES - A MINIMUM OF ONE (1) BANK REFERENCES MUST BE SUPPLIED WITH ALL INFORMATION COMPLETE.

Name
Address
City
State
ZIP
Phone
FAX
Email


CREDIT REFERENCES - FOUR (4) CREDIT REFERENCES MUST BE SUPPLIED WITH ALL INFORMATION COMPLETE

Name
Address
City
State
ZIP
Phone
FAX
Email



Name
Address
City
State
ZIP
Phone
FAX
Email


TERMS: Net due 10th of the month after the month of purchase. Unpaid accounts 30 days after statement date will be charged a 1.5% (18% annual rate) finance charge per month. Finance charges will have to be paid to maintain an open account. By signing this you agree by these terms.

Please use your mouse to sign -- (Left click and hold in yellow area to sign)
Customer Signature


Customer Name
Date Formatt: YYYY-MM-DD

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