Penreco | Customer Service - Credit Application

Credit Application

There are four parts to this application, each of which you may fax separately if you choose.

Contact Information
I will fax this information separately.

Business Name:	Telephone:
Parent Company Name:	Resale Permit Number:
Name of Former Owner:	Previously a cash sale customer? Customer Number:
	Partnership Proprietorship Corporation State of Incorporation:

Mailing Address:

Delivery Address:

Former Address: If less than two years

Property is:
Owned Leased

Information about the Mortgage Co. or Landlord

Name:
Telephone:

Date Business Opened:
- - Address:

Partners, Owners or Corporate Officers I will fax this information separately.
1.
Name: Title: Phone: Social Security Number:	Address:
2.
Name: Title: Phone: Social Security Number:	Address:

Trade References: Give only names of those you buy from an open account. I will fax this information separately.
1. Company Name: Account Number: Person to Contact: Telephone:
2. Company Name: Account Number: Person to Contact: Telephone:
3. Company Name: Account Number: Person to Contact: Telephone:

Bank Information: I will fax this information separately.
Bank Name: Branch: Person to Contact: Telephone:	Address:
Fax voided bank deposit slip
Account Number	Account Number
No. of Loans:

The above information is correct. The undersigned agrees to pay for all merchandise ordered according to the terms stated on the invoice(s). If any amounts are not paid within such terms, they shall be considered delinquent. The undersigned agrees that Penreco may assess a finance change on all delinquent amounts at the lower of one and one-half percent(1-1/2%) per month or the highest rate allowed by law. Additionally, the undersigned agrees to be liable for Penreco's reasonable collection costs and attorney fees should delinquent account be referred to a third party for collection.
Should a credit availability be granted, all decisions with respect to the extension or continuation of credit shall be at the sole discretion of Penreco, and credit privileges may be terminated at any time without notice. The undersigned hereby authorizes Penreco to verify all information contained herein by contacting appropriate third parties and credit bureaus, and further authorizes such third parties to answer questions regarding their credit experience with the undersigned.

Authorized Signature (Please type your name):

Print Name:

Email:

Phone:

Fax:

Home Address:

Best way to be contacted:
Phone
Fax
E-mail
Estimated Monthly Requirements:

Note: Over $5000 Requires Financial Statement

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