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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