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Joplin Freightliner Parts Department
Joplin Freightliner Parts Department

Joplin Freightliner Credit Application

To establish an account with Joplin Freightliner, please either fill out the form below to provide your information online or click on the link below to obtain a pdf copy of our credit application to either email or fax.
  All fields are required.
Firm Name:
Contact Name:
Email Address:
   
  BILL TO:
Address:
City:
State:
Zip:
Phone Number: --
   
  SHIP TO:
Same as billing address.
Address:
City:
State:
Zip:
Phone Number: --
   
Firm Type: Partnership
Corporation
Other
Years In Business:
Name of President:
Name of Controller:
   
  BANK INFORMATION:
Bank Name:
Bank Address:
Bank City:
Bank State:
Bank Zip:
Bank Phone Number: --
   
  TRADE REFERENCES (please provide 3)
Reference 1 Name:
1. Address:
1. City:
1. State:
1. Zip:
1. Phone Number: --
   
Reference 2 Name:
2. Address:
2. City:
2. State:
2. Zip:
2. Phone Number: --
   
Reference 3 Name:
3. Address:
3. City:
3. State:
3. Zip:
3. Phone Number: --
   

IF TAX EXEMPT, PLEASE SEND TAX FORM
I certify to Joplin Freightliner that the above information is true and correct. I authorize Creditor to investigate and otherwise verify the completeness and accuracy of the foregoing application as well as any other matters directly or indirectly bearing on the creditworthiness of the applicant named above. I hereby state that Creditor may rely on the foregoing statements as being accurate without further inquiry. I authorize any person or entity having knowledge of the creditworthiness of applicant to disclose credit, asset and liability information, pertaining to applicant, Creditor and a photocopy of this document shall have the same force as an original for purposes of such authorization. In the event if Creditor shall retain the services of legal counsel or collecting any debt which applicant owes to Creditor, applicant agrees to reimburse Creditor for Creditor's reasonable legal fees incurred in such collection effort together with interest on all past due sums at a rate of 18% per annum from the due date until paid.
   
Signed By*: Title:
*By typing your name above, you agree that this constitutes as a signature.
   
In order to induce Joplin Freightliner ("Creditor") to extend financial accommodation for the account ("Debtor") now and in the future, whether such financial accommodation is in the form of selling goods, material or services on credit, or otherwise, the undersigned ("Undersigned") hereby unconditionally guaranties payment when due of any and all indebtedness ("Debt") of Debtor in endeavoring to collect any of the Debt or in enforcing this Guaranty. The Undersigned expressly waives: presentment demand and protest; notice of acceptance of this Guaranty; notice of the creation of any Debt; and notice of non-payment on the Debt. Creditor may, from time to time, without notice to or consent any of the Undersigned, and without in any way affecting any of the Undersigned's liability or Creditor's rights, alter, accelerate, extend, renew or change the time, place, manner or terms or payment of or grand indulgences with respect to any of the Debt.
Guarantor 1:
Guarantor 2:
   
  All fields are required.
 
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