Credit Application

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What Best Describes You?

Name

Email

Phone number

Fax Number (If Applicable)

Address

City

State

Postal code

Is Business?

Yes No

Business Name

Type of Business

Type of Entity

Individual Corporation LLC Partnership Other

DUNS Number

Federal Tax ID / EIN Number

Business is Taxable

(If no, tax exemption certificate must be furnished with application)

Yes No

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Invoice Mailing Address

Same at Address as Above

Invoice By Email

Statement By Email

Purchase Order is Required for Payment

Electronic Payments Accepted. Please select if you would like the Credit Department to contact you with additional details.

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Applicant Signature*

Applicant’s signature attests: (1) That he/she has full power and authority to execute this application on behalf of the entity applying for the credit; (2) that the execution has been duly and validly authorized by all necessary corporate or other action required by the applicant entity; (3) that the applicant has read and shall comply with the terms and conditions set forth.

The below information, as well as that given above are for the purpose of obtaining credit and are warranted to be true and correct. I/We herby authorize PENN Detroit Diesel, Allison, LLC to investigate the references listed pertaining to my/our credit and financial responsibility.

I Agree With This Application

Name

Title

Date

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