Credit Application PrimeGuard Filtration Commercial Credit Application Please complete the following information to apply for commercial credit terms with PrimeGuard Filtration. Company Information Legal Business Name * DBA / Trade Name Billing Address * City * State * ZIP Code * Shipping Address Shipping City Shipping State Shipping ZIP Main Phone * Website Year Established Federal EIN Business Type Select Corporation LLC Partnership Sole Proprietorship Other Industry / Type of Business Accounts Payable Information Accounts Payable Contact * Accounts Payable Phone Accounts Payable Email * Purchase Order Required? Select Yes No Tax Exempt? Select Yes No Tax-exempt customers should provide a current tax-exemption certificate. Owner / Principal / Authorized Officer Name * Title * Business Phone Email Trade References Trade Reference #1 Company Name * Contact Name Phone Email Current Terms Trade Reference #2 Company Name * Contact Name Phone Email Current Terms Trade Reference #3 Company Name * Contact Name Phone Email Current Terms Credit Authorization The undersigned certifies that the information provided in this application is true and complete and is submitted for the purpose of establishing commercial credit with PrimeGuard Filtration. Applicant authorizes PrimeGuard Filtration and its representatives to contact the trade references listed above and to obtain business credit information reasonably necessary to evaluate this application and the applicant's continued creditworthiness. Approval of this application does not obligate PrimeGuard Filtration to extend credit on any particular order. PrimeGuard Filtration reserves the right to establish, modify, suspend, or revoke credit terms or credit limits at its discretion. Applicant agrees to pay all invoices according to the payment terms stated on the applicable invoice or account agreement. I have read and agree to the credit authorization above. Authorized Representative * Title * Electronic Signature * Date * Submit Credit Application
