Type of Service:* Referred By: Apply for Credit at
 
Company Name:* First Name:* Last Name:*
 
Year Established:* Business Phone:*  
 
Billing Address:* City:* State:*             Zip:*
      
 
Delivery Address:*  
Delivery Address:* City:* State:*             Zip:*
      
 
Type of Organization:*
 
 
 
PERSONAL INFORMATION ON OWNER / PRINCIPAL / GUARANTORS
Name:* Title:*  
 
 
Address:* City:* State:*             Zip:*
      
 
Phone Number:* Birthdate:* Social Security No.:*
/ /
 
% Ownership:* Net Worth:       Annual Income: Monthly Housing Payment:
 
  Add Additional Information:
 
 
 
 
Name: Title:  
 
 
Address: City: State:             Zip:*
      
 
Phone Number: Birthdate: Social Security No.:
/ /
 
% Ownership: Net Worth:       Annual Income: Monthly Housing Payment:
 
  Add Additional Information:
 
 
 
 
Name: Title:  
 
 
Address: City: State:             Zip:
      
 
Phone Number: Birthdate: Social Security No.:
/ /
 
% Ownership: Net Worth:       Annual Income: Monthly Housing Payment:
 
  Add Additional Information:
 
 
 
 
Name: Title:  
 
 
Address: City: State:             Zip:
      
 
Phone Number: Birthdate: Social Security No.:
/ /
 
% Ownership: Net Worth:       Annual Income: Monthly Housing Payment:
 
 
 
 
Type of Business:* CA Sales Tax Permit No.:  
 
 
Purchasing for Resale:* (If yes, certificate required)
 
 
 
 
Insurance Agent: Contact Name: Phone Number:
 
 
 
TRADE REFERENCES (Suppliers)
Name: Phone Number:  
 
 
Address: City: State:             Zip:
      
     
  Add Additional Information:
 
 
 
Name: Phone Number:  
 
 
Address: City: State:             Zip:
      
     
  Add Additional Information:
 
 
 
Name: Phone Number:  
 
 
Address: City: State:             Zip:
      
     
  Add Additional Information:
 
 
 
Name: Phone Number:  
 
 
Address: City: State:             Zip:
      
 
 
 
BANKS, SAVINGS & LOAN ASSNS., CREDIT UNIONS, ETC. AT WHICH ACCOUNTS ARE LOCATED
Name:* Phone Number:*  
 
 
City:* State:*             Zip:*  
        
 
Account Number:*    
   
 
  Add Additional Information:
 
 
 
Name: Phone Number:  
 
 
City: State:             Zip:  
        
 
Account Number:    
   
 
  Add Additional Information:
 
 
 
Name: Phone Number:  
 
 
City: State:             Zip:  
        
 
Account Number:    
   
 
  Add Additional Information:
 
 
 
Name: Phone Number:  
 
 
City: State:             Zip:  
        
 
Account Number:    
   
 
 
Applicant and each other person signing below warrants that the information provided herein or in connection with this application is true and correct and authorizes the release of such information to any party who may provide credit to applicant, whether herein or pursuant to a subsequent application or request, to obtain from banks, credit bureaus and other creditors, all of which are hereby authorized to release, any credit/financial information concerning applicant or such other person (including personal credit bureaus) as such party may deem appropriate, and to share such information with the other. AN ELECTRONIC MAIL OF THIS AUTHORIZATION SHALL BE CONSIDERED AS EFFECTIVE AND VALID AS THE ORIGINAL. I/we agree to pay our account according to the terms of sale as shown on Peterson invoices, including a finance charge of 1.5% per month wihich may be assessed on past due balances. In the event Peterson commences suit to enforce payment of this account the client agrees to pay reasonable attorney's fees and court costs as incurred. Notice: If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please contact: Credit Manager, Peterson Tractor Co., P.O. Box 5258, San Leandro, CA 94577
 
DISCLAIMER