Date of Application: Credit Requested:
Are Purchase Orders Required?
Corporate Name: D/B/A:
Dun & Bradstreet: Dun & Bradstreet Rating:
Mailing Address: Telephone:
Street
Fax:
City, State, Zip
A/P Contact:
A/P Contact E-Mail:
If Company is a branch or subsidiary, list name, address and phone of parent company:
Name:
Address:
Telephone:
Street
Fax:
City, State, Zip
COMPANY INFORMATION
Corporation Partnership Limited Liability Co. Sole Proprietorship Other _____________
Date you started business/assumed control: Number of Employees:
Nature of the Business: Federal ID Number:
Business is registered in what state? Filing Date:
VA, WV, or NC Sales Tax Exemption?
OFFICERS & PRINCIPALS
Name: Title:
E-Mail: Phone:
Name: Title:
E-Mail: Phone:
BANK REFERENCE (must include fax/email )
Bank Name: Account Type:
Bank Contact: Account Number:
E-Mail:
Address:
Telephone:
Street
Fax:
City, State, Zip
TRADE REFERENCES (all references must include fax/email)
Name: Account Number:
Address:
Telephone:
Street
Fax/Email:
City, State, Zip
Name: Account Number:
Address:
Telephone:
Street
Fax/Email:
City, State, Zip
Name: Account Number:
Address:
Telephone:
Street
City, State, Zip
APPLICATION FOR CREDIT
If Exempt, submit proper Certificate. Sales will be taxed without Certificate on file.
Please return by Fax: (757) 485-0232 or Email: Danielle.Armijo@baydiesel.com
Fax/Email:
PAYMENT TERMS: NET 30 DAYS. A 2% finance charge will be assessed on invoices not paid within 30 days.
Authorized Signature Date
Please Print Signed Name and Title
NOTE: Authorized signature must be from a signator on the trade and bank accounts.
TO: BAY DIESEL CORPORATION
In consideration of the extension of credit granted by Bay Diesel Corporation to ________________________________________________
Signed Proprietor or Principal Date
Please Print Signed Name
Address:
Street
City, State, Zip
Phone Number:
Social Security Number:
Wire Transfer Information:
SunTrust Bank, N.A. Bay Diesel Corporation
P.O. Box 2600
Account# 203403223
Norfolk, VA 23510 Internatinal Swift Code: SNTRUS3A
ABA# 061000104
The information set forth above, together with any information supplied in connection herewith, is provided for the purpose of
obtaining or maintaining credit with Bay Diesel Corporation, is represented and warranted to be true, and you may consider the
information as continuing until a written notice of change is given. You, our bank, any credit bureau or other investigating
agency employed by you are authorized to make all inquiries you deem necessary to investigate the references herein listed and to
verify the accuracy of the statements or other data obtained and to otherwise determine the creditworthiness and financial
responsibilities of the undersigned. The undersigned agrees to pay for all services and charges places by the undersigned in
accordance with the credit terms, conditions and general information of Bay Diesel Corporation. The extension of credit may, in
the sole discretion of Bay Diesel Corporation, be increased or decreased at any time and for any reason.
(name of account) I hereby personally, individually and unconditionally guarantee payment of whatever amount, which at any time shall be
owing to Bay Diesel Corporation on account of goods delivered, after the date hereof. This is a continuing guarantee relating to any
indebtedness, including that arising under successive transactions, which shall either continue to indebtedness or from time to time renew after
it has been satisfied. This guarantee shall be perpetual as to any indebtedness incurred before written notice is received by Bay Diesel
Corporation that I am unwilling to guarantee any additional indebtedness on this account. I understand and agree to pay a 2% per month
delinquency and finance charge applied to any balance outstanding 30 days or more, computed on a daily basis. Delinquency and finance
charges will not however, exceed the maximum allowed by state or federal law.
Please note that Bay Diesel currently accepts cash, check, a bank wire transfer, and Visa, MasterCard and American Express credit cards for
payment. However, if you prefer to pay by credit card, a 3% convenience fee will be added to your total payment.
Invoices paid by check, please mail your payment to our CHESAPEAKE office address listed.
PAYMENT ACCEPTANCE NOTICE
APPLICATION FOR CREDIT
click to sign
signature
click to edit
1004 HOLLY SPRING AVE
RICHMOND, VA 23224 (804)
230-3495
Fax (804) 230-3497
3736 COOK BLVD
CHESAPEAKE, VA 23323
(757) 485-0075
Fax (757)485-0232
3022 WENTWORTH AVE NW
ROANOKE, VA 24012
(540) 266-7996
Sales, Service & Parts for Industrial Marine & Power Needs
CREDIT or BANKING REFERENCE RELEASE
In order to process your credit application, we need your permission for your references to release
information about your company. Therefore, we would ask that you please endorse and submit this form
along with your completed credit application, authorizing your references to furnish us with the credit
information we require prior to establishing credit on your behalf. We also ask that you note that we
require three trade references reflecting satisfactory payment history equal to the amount of credit you are
attempting to establish with Bay Diesel Corporation.
Once your credit references have been contacted and the necessary information obtained to establish an
account on your behalf, you will be sent a letter indicating your account number and detailing that our
terms are payment in full 30 days from the date of invoice. This letter will also advise you that a 2% per
month finance charge will apply on any and all late payments. This letter will also require your
authorized representatives signature agreeing to our terms and returned to us prior to your account being
activated.
Bay Diesel Corporation appreciates your business and we look forward to a long and mutually successful
relationship with your company.
Very truly yours,
J. Scott Wheeler
President
By Signature below, I am giving my permission for you to furnish credit and/or banking information to
Bay Diesel Corporation. This permission applies at all times the account is active including annual and
semi-annual reviews of account.
Authorized Signature Date
Printed Name and Title
Company Name
NOTE: Must be signed by an authorized signer on your bank account and returned with credit application.
195 WINDING WOODS LN
ROMANCE, WV 25248
304-988-1316
Fax: 540-301-3602