CREDIT APPLICATION
PETROLEUM EQUIPMENT COMPANY
Phone 1-800-530-7867 Fax 1-601-936-8119
Date ________________________ P.O. # Required Yes No
Trade Name _____________________________________________________________
Street Address ___________________________________________________________
Mailing Address __________________________________________________________
City ____________________________ State ______ Zip _____________________
Telephone Number ________________________________________________________
Nature of Business __________________________________________________
A / P Contact _________________________ Phone Ext # ______________________
Circle one: Corporation Partnership Individual Other ________________________
Owner or Principal Officer / Title ______________________________________________
Credit Limit Desired _____________ Years in Business _________________________
Bank ___________________________________________________________________
Bank Contact ________________________ Phone No. _________________________
Credit References:
Name, Address, Phone No. and Fax No.
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Circle Type of Account End User Reseller
If you are tax exempt or carry a special tax rate, please complete our tax
exemption certificate and
return with a copy of your tax permit / MPC / Direct Pay / OEM/ etc.
I agree that my account shall be assessed 1.5% service charge on any
balance over 30 days old.
Signature _________________________________________________________
PETROLEUM EQUIPMENT COMPANY
Phone 1-800-530-7867 Fax 1-601-936-8119
Date ________________________ P.O. # Required Yes No
Trade Name _____________________________________________________________
Street Address ___________________________________________________________
Mailing Address __________________________________________________________
City ____________________________ State ______ Zip _____________________
Telephone Number ________________________________________________________
Nature of Business __________________________________________________
A / P Contact _________________________ Phone Ext # ______________________
Circle one: Corporation Partnership Individual Other ________________________
Owner or Principal Officer / Title ______________________________________________
Credit Limit Desired _____________ Years in Business _________________________
Bank ___________________________________________________________________
Bank Contact ________________________ Phone No. _________________________
Credit References:
Name, Address, Phone No. and Fax No.
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Circle Type of Account End User Reseller
If you are tax exempt or carry a special tax rate, please complete our tax
exemption certificate and
return with a copy of your tax permit / MPC / Direct Pay / OEM/ etc.
I agree that my account shall be assessed 1.5% service charge on any
balance over 30 days old.
Signature _________________________________________________________
