PAC-Green

General Information

Firm Legal Name
Street Address
City, State & Zip
Contact Name
Accounting Email
Accounting Fax
Trade Name
Mailing Address
City, State & Zip
Phone
Sales Email
Sales Fax
How do you wish to receive your invoices?
Please provide email address for invoices
Is business a
Date business started
Full name of Owner/Officers
Tax Exempt

Credit References

Banks

Name
City, State & Zip
Fax/Email
Address
Phone
Account #
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Suppliers

Name
City, State & Zip
Fax/Email
Address
Phone
Account #
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Bank Authorization

To establish credit or update credit information, we authorize [enter bank name] to provide account balances, loan information, and other pertinent information to Petersen Aluminum Corporation.

Company Name
Authorized signature
IP logged as 54.225.57.230
Title
Date
actual time logged as Tue, 14 Aug 2018 05:31:00 -0500
For any additional paperwork including Company Tax Exempt certificates, please fax or email to your branch credit manager.

Electronic Signature

Your Electronic Signature below verifies that you, the applicant, hereby requests open account status, authorizes normal inquiries needed to evaluate this request. We certify that all information on this form is correct.

Full Name
Title
Date

By filling out the form above you are electronically submitting this information to Petersen Aluminum. A PDF will also be forwarded to the email address you entered above. You can keep this copy for your records. You will also have an option to download a copy of the PDF after pressing the submit button. If you do not wish to use the electronic version of this form you can download a fillable PDF form here by clicking the button below and submit it via Mail or Fax.

Download PDF Version

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