Chiles Enterprises: Credit Application

1-800-244-0340
931-424-4189
931-424-7198 (fax)
















	Chiles Enterprises 956 W. College St. Pulaski, TN 38478 info@chilesoilpacpri.com © 2001 Chiles Enterprises

In order to open an account with Chiles Enterprises, all you need to do is fill out a credit application. Option 1: download the form in PDF format. Option 2: fill out the form online, print it, and fax or mail it to Chiles Enterprises.

Option 1: Download the form in PDF format

Just click below, download the form, print it, fill it out, and mail or FAX it to us.

Click Here to Download the PDF

Option 2: Fill out the form online

Rather than print the form and fill it out by hand, you can also fill out the form below in your web browser, print this page, and send it in to Chiles Enterprises.

Business Information
Name of Business	Address
City	State	Zip Code	Phone
Are you presently a Pacific Pride card holder? Yes No	When did you last use your card?

Business Legal Structure		Name and Address of Parent Company
Years in Business	Type of Business
Federal ID Number		Phone Number

Company Principals Responsible for Business Transactions
Name	Title	Social Security Number	Date of Birth

Home Address

City

State

Zip Code

Have you ever filed bankruptcy?

When

Where

Home Phone

Bank References
Name of Bank	Name to Contact
Bank Branch	Bank Address
Checking Account Number	Telephone Number

Trade References
Firm Name (1)	Firm Contact (1)	Firm Telephone (1)	Firm City and State (1)
Firm Name (2)	Firm Contact (2)	Firm Telephone (2)	Firm City and State (2)
Firm Name (3)	Firm Contact (3)	Firm Telephone (3)	Firm City and State (3)
Firm Name (4)	Firm Contact (4)	Firm Telephone (4)	Firm City and State (4)

Annual Gallonage Estimate	No. Vehicles	No. Drivers
Person to Contact Regarding Cards		Phone Number

I hereby certify that the information in this credit application is correct. The information included in this credit application is to be used to determine the amount and conditions of credit to be extended. I understand that the other sources of credit considered necessary in making the determination may also be used. Further, I hereby authorize the bank and trade references listed in this credit application to release the information necessary to assist in establishing a line of credit. Billings shall be issued twice month and payment will be due in full within 10 days of invoice date. I agree to pay a late charge of 1 1/2% per month (18% per year) or $0.50 minimum on any delinquent balances. This agreement includes the terms and conditions on the reverse side hereof. Not withstanding that this account is established in the name of the

company, I personally guarantee payment of the account. All purchases made on this account will be for commercial use.

Signature

Click here for additional terms of cardlock use.

Date