Customer Credit Application

Click Here to Download a faxable PDF version of this Document

Contact Name:

Date:

Company:

Billing Address:

City:

State/Province:

Zip Code:

Shipping Address:

Same as Billing Address

City:

State/Province:

Zip Code:

Controller:

Purchasing Agent:

Telephone:

Fax:

Background Information

Designation

Corporation Partnership Proprietorship

Officers or partners

Type of business

Year business established

Federal ID #

Bank References

Bank

Address

City

State/Province

Zip

Telephone

Fax

Checking Account #

Contact Person

Trade References

Please list three credit references. Fax numbers are required to process your
application.

Company 1

Address

City

State/Province

Zip

Telephone

Fax

Company 2

Address

City

State/Province

Zip

Telephone

Fax

Company 3

Address

City

State/Province

Zip

Telephone

Fax

Sales taxable?

Yes No

(If no, return exemption certificate with application. Failure to include exemption certificate can delay credit approval.)

The buyer agrees to the terms of sale of Bushman Equipment, Inc. and agrees to pay all invoices within 30 days of invoice date.

The buyer further agrees that in the event of nonpayment or late payment, the highest legal rate of interest allowed will be paid on all past due balances.

The undersigned has read and agrees to the above terms.

Signed by

Name
Title
Date

* Validation Code
Validation Image

Enter the validation code you see to the left

Customer Credit Application

Affiliates

Memberships