4904 West 12th Street · Sioux Falls, SD 57107
Telephone (605) 336-0405 Fax (605) 336-2280
Locations in Sioux Falls, SD - Mitchell, SD - Watertown, SD - St. Cloud, MN-Newport, MN
CREDIT APPLICATION
TO BE COMPLETED BY APPLICANT:(Please print or type) Date:______
Legal Business Name: ______
Trade Name(s): ______
Billing Address: ______
______
City: ______State: ______Zip:______
Telephone Number: (____) ______Fax Number: (___) ______
Email Address: ______
Type of Business: ______Purchasing Manager ______
# Of Years Under Current Ownership: ______Number of Employees ______
Line of Credit Requested: ______Anticipated Monthly Purchases:______
Delivery Address: (if different) ______
______
Type of Business
Corporation Partnership Proprietorship Other (specify)______
Principals: Name and Title of Officers or Owners:
______
______
Bank References
Name of Bank: ______Contact ______
Address: ______
City: ______State: ______Zip: ______
Telephone Number: ( )______Fax Number: ( )______
Checking Account #: ______Savings Account #: ______
Loan Account #: ______Other: ______
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Trade References
- Company Name: ______
Address: ______
City: ______State: ______Zip: ______
Telephone Number: (____) ______Fax Number: (___)______
Name of Individual to Contact: ______
Email Address ______
Account Open Since ______Account #: ______
- Company Name: ______
Address: ______
City: ______State: ______Zip:______
Telephone Number: (____) ______Fax Number: (___)______
Name of Individual to Contact: ______
Email Address ______
Account Open Since ______Account #: ______
- Company Name: ______
Address: ______
City: ______State: ______Zip: ______
Telephone Number: (____) ______Fax Number: (___)______
Name of Individual to Contact: ______
Email Address ______
Account Open Since ______Account #: ______
Providing e-mail addresses and fax numbers will expedite the credit approval process
This Applicant agrees to pay late charges equal to the maximum amount allowed by law but not to exceed 1.5% per month
on any balances past due. The Applicant by executing this credit application hereby agrees to indemnify and save harmless Wheelco, its directors, officers, employees, agents, successors and assigns from all claims, damages, demands, suit, liabilities or causes of action of every kind and nature whatsoever that are a result of any misuse of, or damage to, the products purchased from Wheelco by the Applicant’s employees, agents and customers.
We authorize Wheelco to obtain information from our credit and bank references. Wheelco will keep all information in strict confidence.
Authorized Applicant: ______Title ______
Signature
Please note: In order for Wheelco to consider establishing credit for you, the following conditions must be met:
1. This application must be signed. 2. At least three major trade references and one bank reference must be furnished.
3. To obtain sales tax exemption, please fill out the sales tax exemption form and return it with the credit application.
Please mail the completed application to: 4904 W 12thStreet ∙ Sioux Falls, SD 57107,
fax to: 605-336-2280 or e-mail to .
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