Commercial Credit Application

Business Name
Street Address 
City State Zip
Telephone Number 
Type of Business:
Proprietorship  Partnership  Corporation 
If not incorporated, must provide Social Security Number.

Email address


Billing Address (If different from above)

Street Address
City State Zip

Credit References

Please List Three Credit References

Reference #1 Name

Street Address
City State Zip
Account Number

 

Reference #2 Name

Street Address
City State Zip
Account Number

 

Reference #3 Name

Street Address
City State Zip
Account Number


Other Information We Need

Our Credit Cards require a PIN number for proper security purposes.  We will need a list of everyone authorized to charge on your account and a selected 4-digit PIN number.  Example:  John Doe #1000, Jane Doe #1001, Susie Doe # 1002.  Everyone must have a different 4-digit PIN number.  These numbers are necessary in order to accurately process your statements with a detailed listing of all account transactions according to each user.  Please provide us with this information by emailing your list of authorized users and PIN numbers to comments@gosimonson.com.  If you have any questions concerning this process, please call 1-701-772-3971 and ask for Brent.


Special Requests

Credit Card Request
Card on file at stores only  Card issued to applicant  Cards issued and put on file 

If cards are issued, how many cards are required? 
 


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