• Customer Information

  • (Full Legal Name)
  • (Public, Corporation, Partnership, Sole Proprietor, Gov't)
  • Banking Information

  • Trade References

    Please provide four (4) parts/service vendor references
  • Sales/Use Tax

    If exempt, please include certificate for exemption, resale, direct pym't certificate, ect. for each applicable state.
  • Credit Terms:

    All charges due Net 30 days, from the invoice date in US Funds. A service charge of 2% a month will be added after the due date. Customer agrees to pay all collection costs and expenses, including legal incurred by Kenworth Northeast Group, Inc. in the event of a default.
  • Certification and Agreement:

    I certify that all the information on this application is correct, I/We fully understand and agree to the stated credit terms, I/We agree to have Kenworth North Group, Inc. contact any and all references listed above.
  • MM slash DD slash YYYY