PIPER PARTS PLUS CREDIT APPLICATION – PRINT AND FAX ONLY

Piper Parts Plus 3746 Distriplex Drive North Memphis, TN 38118 Credit Dept: 866-89PARTS, Fax (901) 375-2606 credit@piperpartsplus.com

REMIT TO: Piper Parts Plus P.O. Box 1000; Dept. 433 Memphis, TN 38148-0026 866-89PARTS

Request for Open Account

Please check one: __Corporation __Partnership __Proprietorship

ENTITY LEGAL NAME
TRADE NAME
BILLING ADDRESS		SHIPPING ADDRESS
CITY	STATE\ZIP	TELEPHONE	FAX NUMBER
PRIMARY PARTS CONTACT	ACCOUNTS PAYABLE CONTACT	DATE BUSINESS STARTED	STATE INCORPORATED

TYPE OF BUSINESS

AMOUNT OF CREDIT REQUESTED

Officers or Owners Names

Home Address and Telephone Number

Trade Credit References
	COMPANY NAME	CITY\STATE\ ZIP	TELEPHONE	FAX NUMBER
	COMPANY NAME	CITY\STATE\ ZIP	TELEPHONE	FAX NUMBER
	COMPANY NAME	CITY\STATE\ ZIP	TELEPHONE	FAX NUMBER

Bank Reference
BANK NAME	BANK OFFICER	ADDRESS	CITY\STATE\ ZIP

THE UNDERSIGNED WARRANTS THE INFORMATION GIVEN TO BE TRUE. P3 IS AUTHORIZED TO INVESTIGATE THE REFERENCES HEREIN, STATEMENTS OR OTHER DATA OBTAINED FROM MY COMPANY OR FROM ANY OTHER PERSON PERTAINING TO MY CREDIT AND FINANCIAL RESPONSIBLIITY. ALL CHRGS ARE DUE AND PAYABLE BASED UPON TERMS ON INVOICE. A LATE PAYMENT CHARGE OF 1.5% PER MONTH PLUS ATTORNEY'S FEE, IF NECESSARY FOR COLLECTION, WILL BE ADDED TO ANY BALANCE NOT TIMELY PAID. A $25.00 FEE WILL BE ASSESSED FOR EACH NSF CHECK

I HAVE READ, UNDERSTAND AND AGREE TO THE ABOVE CONDITIONS.

BY

OFFICER

DATE

If your company qualifies for tax-exempt purchases, please complete the Resale Certificate below.
	Blanket Certificate of Resale Multi-State	TO: P3, VENDOR
	NAME OF PURCHASER		SALES TAX REGISTRATION NO.
	ADDRESS		TYPE OF BUSINESS
	BY (SIGNATURE)		DATE

TO CERTIFY TAX-EXEMPT STATUS, PLEASE PROVIDE THE APPROPRIATE STATE REGULATED RESALE CERTIFICATE.