Credit Application

Applicant Information

Please complete the form below, including all required fields and submit application.

Full Name of Firm or Individual*

Doing Business As

Please provide if applicable.

Billing Address*

Street Address City State ZIP Code

Shipping Address*

Street Address City State ZIP Code

Phone Number*

Fax Number*

Mobile Number*

Email Address*

For invoices and statements.

Website Address

Number of Years in Business*

Are Purchase Orders Required?*

Yes
No

Business Type*

Corporation
Partnership
Individual

Federal ID Number*

DUNS Number*

Owners and Officers

List name(s) of owner(s) or officer(s) and required details.

Name*

Social Security Number*

Title*

Name

Social Security Number

Title

Management Contacts

President*

Sales Manager

Parts Manager

Service Manager

Business Operations*

If applicable, we must have a sales tax exemption form filled out and signed for our files.

Central Power Sales Representative*

Please include your sales rep's name.

Business References

Please include all three references.

Business Reference #1 Address*

Street Address City State ZIP Code

Business Reference #1 Email Address*

Business Reference #1 Phone Number*

Business Reference #1 Fax Number*

Business Reference #2 Address

Street Address City State ZIP Code

Business Reference #2 Email Address

Business Reference #2 Phone Number

Business Reference #2 Fax Number

Business Reference #3 Address

Street Address City State ZIP Code

Business Reference #3 Email Address

Business Reference #3 Phone Number

Business Reference #3 Fax Number

Bank Reference

Bank Name*

Bank Address*

Street Address City State ZIP Code

Bank Officer Email Address*

Bank Phone Number*

Bank Fax Number*

Credit Agreement

Agreement Terms*

I have read and agree to the Central Power Systems & Services, LLC Credit Agreement.

By signing below, we agree to Net 30 day terms, unless otherwise stated on the individual invoice. We agree that if payment is not received 30 days from the date of the invoice, we will be responsible for any and all interest charges of 1.5% per month (18% per annum). It is agreed that buyer will be responsible for all costs of collection, including a reasonable sum for collection or attorney fees, for any unpaid balance.

This credit agreement shall be construed, governed, interpreted and applied in accordance with the laws of the State of Missouri. The Clay County Circuit Court shall have jurisdiction over all controversies and/or litigation, which may arise with respect to the negotiation, execution and compliance of this credit agreement. The parties hereby waive any other venue to which they may be entitled by virtue of domicile or otherwise.

We certify that all information on this form is warranted to be correct and that we fully understand the credit terms above. We hereby authorize Central Power Systems and Services to investigate the references listed pertaining to our credit and financial responsibility and to release credit information about their credit experience with us.

We hereby grant Central Power Systems and Services, L.L.C. (“Central Power”) a purchase money security interest in all products purchased from Central Power. Furthermore, Central Power is authorized to file one or more Uniform Commercial Code financing statements with the appropriate filing office(s) naming applicant as debtor, in order to perfect its security interest in all products purchased. Title to all goods sold to applicant shall not pass to the applicant until payment for all goods have been received by Central Power.

Personal Guarantee

Guarantee of Payment

I have read and agree to the guarantee of payment terms.

In consideration of the extension of credit to applicant, the undersigned personally guarantees payment of all advances, credits and related service charges made by Centra Power Systems & Services, Inc. to applicant, together with collection costs, including reasonable attorneys' fees where allowed by law.

Digital Signature*

The parties agree that facsimile and electronic signatures shall be equally valid and binding as original signatures.

Applicant Information

Owners and Officers

Management Contacts

Business References

Bank Reference

Credit Agreement

Personal Guarantee

Tax Exemption Forms

Quick Links

Products

Services