Confidential Credit Application – Barksdale Sales Group

Required

PLEASE PROVIDE A COPY OF YOUR MOST RECENT AUDITED FINANCIAL STATEMENT TO SUPPORT THIS APPLICATION.

Upload statements below.

Click or drag a file to this area to upload.

A/P Contact Information

Layout

Name: *

First

Last

Fax Number:

Phone:

Email: *

Trade References

Layout

Name: *

Location:

Address Line 1

Address Line 2

City

State

Zip Code

Location:

Address Line 1

Address Line 2

City

State

Zip Code

Location:

Address Line 1

Address Line 2

City

State

Zip Code

Location:

Address Line 1

Address Line 2

City

State

Zip Code

Fax:

Banking Information

Tecumseh Sales Representative: *

Our terms of sale (These terms will be strictly enforced):

WHOLESALER: 1%-10/Net 30

OEM: Net 30

Your Information

Name: *

First

Last

Title:

Company Information

Required

A/P Contact Information

Trade References

Banking Information

Our terms of sale (*These terms will be strictly enforced*):

Your Information

Our terms of sale (These terms will be strictly enforced):