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Credit Application

Please fill out the form below to submit a credit application.

Fields marked with an asterisk (*) are required.

Service Information

Service Needed By *

Credit Amount *

Sales Department

Sales Person

Division

Applicant Information

What Best Describes You? *

Email *

Phone Number *

Fax (If Applicable)

Address *

City *

State *

Postal Code *

Business Information

Is Business?

Yes No

Business Name

Type of Business

Type of Entity

Other (if applicable)

DUNS Number

Federal Tax ID / EIN Number

Business is Taxable Yes

Invoice Address

Same as Address Above

Invoice By Email Yes

Statement By Email Yes

Purchase Order is Required for Payment Yes

Electronic Payments Accepted. Please select if you would like the Credit Department to contact you with additional details. Yes

Trade Reference 1

Name

Account Number

Phone Number

Address

City

State

Postal Code

Trade Reference 2

Name

Account Number

Phone Number

Address

City

State

Postal Code

Trade Reference 3

Name

Account Number

Phone Number

Address

City

State

Postal Code

Applicant Signature

Name *

Title *

Date *

By submitting this application, you certify that the information is true and complete and authorize Penn Power Group to verify the information provided.