New Customer and Credit Application Form

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12 Characters
1 Uppercase letter
1 Lowercase letter
1 Number
1 Special character

Please tell us about your company so that we can begin to work together.

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CORPORATE OFFICER / OWNER INFORMATION

Corporate Officer / Owner Name and Title

Corporate Owner/Officer Business Address

Corporate Office / Owner Telephone

Corporate Office / Owner Email Address

BANKING REFERENCE

Banking Institution Name

Bank Contact

Bank Telephone

Bank Fax or Email

Bank Routing Number

Bank Account Number

Bank Address

TRADE REFERENCES

Business Name 1

Business Contact Name 1

Business Fax or Email 1

Business Name 2

Business Contact Name 2

Business Fax or Email 2

AGREEMENT TO TERMS

By clicking the submit below, or signing with original signature, I hereby represent that I am authorized to submit this application and bind the business identified in this application, and that the information provided is for the purpose of obtaining credit and is warranted to be true. The business identified in this application hereby authorizes all banks, financial institutions, trade reference sources, credit reporting agencies and others to release credit information. I (We) understand terms for payment are Net 30 Days (unless otherwise negotiated) and that all accounts not paid within terms are past due and are subject to a 1.5% per month finance charge, (18% per annum) subject to change without notice. In addition, we agree to pay all charges on all returned checks on our account; we understand the return check charge is $40.00 per check. All delinquent accounts exceeding their credit limit may not be extended further credit and may be subject to accelerated collections procedures. Buyer agrees to pay the costs and expenses of collection of amount past due, including service charges, legal expenses and attorney fees. We also understand and agree that all litigation will be in the State of Minnesota, Ramsey County. Authorized signer agrees to accompanying terms and conditions for sale.

Authorized Signature

Printed Name / Title

Date of Submission

Pace Information - Enables Us to Connect this Information to the Right Location

Name of Pace Contact You Are Currently Working With?

Pace Location/s You Are Interested in Working With (hold control key while clicking to select more than one location)?

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Contact Information