New Company Account & Credit Application

Account Details

Tax and credit information for your account.

Federal I.D. # (EIN)

Tax Exempt # (if applicable)

Credit Line Requested ($)

Are P.O.'s Required?

Bank References

I hereby authorize Prairie Land Towing to inquire the following banks regarding the standing of my accounts.

Bank Reference #1

Bank Name

City

Contact Person

Phone

Account #

Bank Reference #2

Bank Name

City

Contact Person

Phone

Account #

Trade References

I have recently done business with the following establishments, and authorize Prairie Land Towing to inquire the status of my account.

Trade Reference #1

Business Name

City / State

Phone

Fax

Trade Reference #2

Business Name

City / State

Phone

Fax

Trade Reference #3

Business Name

City / State

Phone

Fax

Trade Reference #4

Business Name

City / State

Phone

Fax

Agreement & Signature

I am furnishing the above information for the purpose of a credit account with Prairie Land Service Center. If my account is granted, I hereby agree to pay all amounts due on the 10th of the following month. If my account were to fall overdue, I agree to pay 1.5% finance charges (18% annually). In the event I do not pay the above finance charges, my account will then be closed.

I have read and agree to the credit terms above. *

Electronic Signature (Type Full Name) *

Title

Print Name *

Date *

Menzel Enterprises, Inc. — Prairie Land Towing & Service Center

New Company Account

Company Information

Account Details

Bank References

Trade References

Agreement & Signature