Panhandle Pro Products Credit Application

Panhandle Pro Products Credit Application

Please Fill Out Complete and Submit
Company Legal Name
Business Address

Street Address

Street Address Line 2
CityStateZip Code
Business Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Contact Person Name

First NameLast Name
Email Address
example@example.com
Accounts Payable Email Address
example@example.com
Type of Business
Years in Operation
Requested Credit Amount (USD)
Purchase Order Required?
Business Sales Tax ID # Note: A Signed Tax Form Will Be Required for Tax Exempt Status
Submit Sales Tax Exemption

Cancelof
D&B Number if Applicable
Trade References or Upload Below Please Submit 2 or More
Optional Upload Credit References Here:

Cancelof
Has any Owner/Officer Been Involved In Personal Or Corporate Bankruptcy?
Additional Specific Request or Comments
Terms of Agreement

The signature(s) below represent and warrants that party(s) signing below is an authorized representative of list company: and that the information provided herein is complete and accurate representation of the company’s financial situation as of the date hereof. Any representation or fraudulent information will be basis for default under this agreement. By signing this form, I expressly authorize Panhandle Pro Products LLC to contact the above credit references to determine creditworthiness. Terms of sale are 20 days net from date of invoice. Interest will be charge at the rate of 18% per annum for past due account more than 60 days past due. All charges for materials sold under this account are expressly payable in Amarillo, Randall County Texas.
Name and Title of Signer
Date

MonthDayYear
Date
Signature
Should be Empty:

Panhandle Pro Products Credit Application

Terms of Agreement