Perkins Parts Store


Apply for Credit

    Permit No.
Taxable or Non Taxable: Yes No Business Classification:
Name of Firm: P.O. Box
Street Address: City:
State: Zip Code:
Phone: Fax:
Corporation Partnership Proprietorship No. of Employees:
D & B Rating: SIC:
Name of President & Treasurer, Owner or Partner: Date Incorporated: Year Incorporated:
If Branch or Division, Location of Home Office:
Person to Contact Regarding Accounts Payable:
Bank Reference: Account No. Address: City: State: Zip: Phone:
Individual Accounts:
Social Security No.:
Employed By:
Local Trade or Business References: (For Individual Accounts, Please Give Account Numbers:
1. Fax No: 4. Fax No:
2. Fax No: 5. Fax No:
3. Fax No: 6. Fax No:
Can you Anticipate Your Monthly Volume with Us?
Yes No If yes, then how much?

I (We) Understand that the information furnished you on this page is for the purpose of obtaining credit from your firm. That I am (we are) authorized, in my (our) capacity, to bind my (our) firm accordingly. That all accounts or monies due you shall be due and payable at 1215 carpenter road, Harris county, Humble, Texas. That all past due accounts, notes or judgments shall automatically draw interest at a rate of 1.5 percent per month.
Name: Title:

In consideration of credit being intended to the about named firm I personally guarantee all indebtedness hereunder. I further agree that this guaranty is an absolute, completed and continuing one and no notice of the indebtness or any extension of credit already or hereafter contracted by or extended need be given. The terms may be rearranged, extended and/or renewed without notice to me. That I will, within five days from date of notice that the account is past due. pay the amount due.
Name: Title: