Peach State Truck Centers Application for Account

Business Type: *
Are you a tax exempt organization? *
If yes, please include a tax exempt certificate for the state of Georgia (ST-5) and Georgia Certificate of Registration (ST-2).
Are Purchase Orders Required? *
 
CREDIT REFERENCES
 
TRADE REFERENCES
IS SHIP TO ADDRESS SAME AS BILLING ADDRESS *
 
SHIP TO ADDRESS (If different from Billing Address)

The undersigned applicant does hereby certify that the information given is true and correct and further agrees to permit PEACH STATE TRUCK CENTERS to use this information to obtain any additional credit information. If, after viewing this information, account privileges are granted the undersigned applicant agrees to and understands that all purchases on open account will be PAID IN FULL on or before the 10th of the month following purchase.

The undersigned applicant also agrees and understands that if the account is not paid in full on or before the 1oth of the month following purchase that PEACH STATE TRUCK CENTERS will charge, and the undersigned agrees to pay, interest on the past due balance at the highest interest rate allowed by law. Undersigned also agrees to pay all collection costs incurred to collect past due balances (including attorney’s fees).

In consideration of the sale of goods and the extension of credit to the above named customer, I hereby personal and individually guarantee payment of all amounts that may hereafter come due and payable to PEACH STATE TRUCK CENTERS by said customer.

Authorization of Electronic Signature: *
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