Simonson

Printable Application

Commercial Credit Application

Business Name

Street Address

City

State

Zip

Telephone Number

Type of Business:
Proprietorship Partnership Corporation

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

Reference #2 Name

Street Address

City

State

Zip

Reference #3 Name

Street Address

City

State

Zip

Other Information We Need
Our Charge Cards require a PIN number for proper security purposes. Please list 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. If you have any questions concerning this process, please call 701-772-3971 and ask for Brent.

Authorized User & PIN

Special Requests

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

If cards are issued, how many cards are required?

By submitting this application I agree to the terms and conditions set forth in the credit card application.

OWNER’S SIGNATURE – PERSONAL GUARANTY
I agree that you may verify all information provided which will include, but is not limited to, my personal credit history, now and in the future. If for any reason the above listed business becomes unable to pay all or any portion of the debt owed to Simonson Station Stores, Inc. (Simonson), I personally guaranty payment in full upon presentment from Simonson’s. The undersigned guarantees the debts in the happening of which include, but are not limited to, death, dissolution, failure of the business, or any petition in bankruptcy being filed against the undersigned. This is a continuing and unconditional guaranty remaining in full force until the debt has been satisfied and written notice has been given to Simonson’s to close the account. I also agree that any unpaid past due balance will accrue a monthly finance charge at a rate of 18% per year.

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