Commercial Account Application
Type of Account being applied for.
*
Please Select
Credit Card Token on File (PREFERRED)
CASH or C.O.D. Account
Please select your serving store location. Your account will work at all Genden Auto Parts store locations.
*
Please Select
Springfield, MA
Agawam, MA
South Deerfield, MA
Greenfield, MA
Shelburne Falls, MA
Wilmington, VT
Walpole, NH
Genden Auto Parts AcDelco Battery Truck
Applicant's Business Name
*
Applicant's Type of Business (e.g., Auto Repair, Auto Body, Tree Service, Fleet Repair, etc.)
*
State Sales Tax Permit #
If you are tax exempt or non-taxable please also fill out the State Tax form found on genden.com
Charge Sales Tax?
*
Please Select
YES
NO
If no please fill out the tax form found on our website that coincides with your sate and tax exemption. If the tax form is not filled out the account will be charged tax until we receive one.
Telephone Number
*
Please enter a valid phone number.
Email Address
*
Purchase Order Number Required
*
Please Select
Yes
No
Physical Ship to Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Billing or Mailing Address if different from above
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Printed Name
*
First Name
Last Name
Signature
*
Submit
Should be Empty: