4636 Waldo Industrial Drive High Ridge, MO 63049
Phone: 636.677.4355   Fax: 636.677.5912
Sieveking Inc. uses industry-standard Secure Sockets Layer (SSL) technology to protect communication between your web browser and our web servers. If you are using either Microsoft Internet Explorer (version 2.1 or later) or Mozilla (version 1.0 or later) as your browser, then your data will be protected by SSL.

 

Sieveking Credit Application
SIEVEKING, INC. 4636 Waldo Industrial Drive, High Ridge, MO 63049    Phone: 636.677.4355   Fax: 636.677.5912
OFFICE USE ONLY
APPROVED BY:
 
TITLE:
 
DATE:
 
SALES PERSON:
 
ACCOUNT NUMBER:
 

 

Your Account Name:
 
BILL TO DETAILS SHIP TO DETAILS
Street Address:
Street Address:
City:
City:
State:
State:
Zip Code:
Zip Code:
Telephone:
Telephone:
Fax:
Fax:
 
COMPANY DATA
Company Type:
Years in Business:
Years at this location:
Sales Tax Exempt:
Federal Tax #:
 
BANKING INFORMATION
Name of Bank:
Savings Number:
Address:
Checking Number:
City:
Loan Number:
State:
Phone Number:
Zip:
 
 
Business Account References
Name Address Fax Only Attention Account Number
 
OWNERS, OFFICERS, PARTNERS, and/or PRINCIPALS
Name:
Name:
Title:
Title:
Social Security (SSN):
Social Security (SSN):
Home Street Address:
Home Street Address:
City:
City:
State:
State:
Zip Code:
Zip Code:
Telephone:
Telephone:
 
Has customer/applicant ever filed bankruptcy?
Court:
Date:
Primary Accounts Payable Contact:
Phone:
Ext:
Secondary Accounts Payable Contact:
Phone:
Ext:
Email For Billing & Statements:
Primary: Secondary:
 
PRODUCTS
Check all appropriate products that you will use:
By signing below, Customer/Applicant agrees to the terms and conditions of sale, as follows:
  • All transport delivery terms are net 10 days from ship date.
  • All other invoice terms are net 20 days from ship date.
  • All invoices over 30 days will be assessed a 1.5% finance charge and are subject to be placed on COD.
  • All Equipment supplied by Sieveking Inc. remains the property of Sieveking Inc. and must be maintained in good working condition by Customer/Applicant, any repairs or replacement due to mistreatment, neglect or abandon will be Customer/Applicants obligation and responsibility.
  • Customer/Applicant shall be liable for all costs of collection, including reasonable attorney's fees, should the account be placed in the hands of an attorney for collection.
  • Customer is solely responsible for product(s) after delivery by Sieveking, including theft, spills, misuse and vandalism.
blank
WAIVER OF JURY TRIAL. THE MAKER(S) AND ANY GUARANTOR(S) HEREBY CONSENT(S) TO THE JURISDICTION OF THE COURTS OF THE STATE OF MISSOURI, WITH VENUE IN JEFFERSON COUNTY, AND WAIVE(S) ANY RIGHT TO TRIAL BY JURY IN ANY LITIGATION RELATING TO ANY DISPUTE ARISING OUT OF OR WITH RESPECT TO THIS AGREEMENT OR ANY OTHER INSTRUMENT, DOCUMENT, OR AGREEMENT EXECUTED OR DELIVERED IN CONNECTION HEREWITH, OR THE TRANSACTIONS RELATED HERETO.
blank
Customer/Applicant Name:
Signature:
 
Print Name:
Title:
Date:

 
PERSONAL GUARANTY(S) In lieu of a financial statement and in order to induce Sieveking Inc. to sell merchandise to this Applicant, the undersigned assume personal responsibility for and guaranty payment of all sums due and payable to Sieveking Inc. by the Applicant/Customer__________________________________, including all costs of collection, including attorney’s fees and court costs should the account be placed in the hands of an attorney for collection.
blank
Signature:
 
Signature:
 
Print Name:
Print Name:
Address:
Address:
Telephone Number:
Telephone Number:
SSN:
SSN:
Date:
Date:
 
Powered by RS Latitude.
A Roadside Systems Company

Home | History | Credit Application | Key Personnel | Lubricants | Products | Unit Fueling | Ultra Low Sulphur Diesel | Contact Us
Copyright � 2009-2010 Sieveking Inc. All rights reserved.