Credit Application

CALL: 423-622-1006

We’re glad you have chosen Southeast Diesel, Inc. for all of your diesel parts and service needs. To open a credit account with us, please complete the following application:

SED Credit Application

Our credit application can be completed on your computer and returned to us via email or printed, completed, and returned via fax.

If you have any questions, please feel free to contact us at 423-622-1006.

Application:
Date:*
Phone:*
Fax:
Company Name:*
Company Address:*
Name of Officer or Owner:*
Title:*
Description of Business:*
Contact person:*
At Present Location Since:*
Year Established:*
Do You Require Purchase Order Numbers?
- Yes
- No
Are You Tax Exempt?
- Yes
- No
Sales Tax #
Federal Tax ID #
Have You or any Principles filed bankruptcy?
- No
- Yes
If Yes, When?
Company or Name filed under:
Payables Manager:
Phone #
Ext #
References:
Reference 1
Bank:
Phone:
Address:
City:
ST/Zip:
Fax:
Contact Person:
Account Number:
Reference 2
Name:
Phone:
Address:
City:
ST/Zip:
Fax:
Contact Person:
Account Number:
Reference 3
Name:
Phone:
Address:
City:
ST/Zip:
Fax:
Contact Person:
Account Number:
Reference 4
Name:
Phone:
Address:
City:
ST/Zip:
Fax:
Contact Person:
Account Number:
Terms are Net 10th. A Finance Charge of 1.5% per month will be added to all unpaid balances. Credit customers Agree to pay reasonable Attorney & Collection Fees in the event Collection Process becomes necessary for delinquent accounts.
Authorized Signature required for release of credit information and agreement to terms & conditions for open account.
Name
This field is for validation purposes and should be left unchanged.

Contact Us

Credit Application

Application:

References: