Online Credit Application

CLICK HERE TO DOWNLOAD OUR CREDIT APPLICATION
Or fill out the Online Credit Application.
  • If billing address is the same as shipping address, leave blank.
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  • Ex.: www.yourwebsite.com
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  • CONTACT PERSONS:

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  • Example: Garage, Service Center, Fleet, Independent Contractor.
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  • Name & TitleAddresssCity, State, Zip 
    Add a new row
    Please list owner or at least two officers.
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  • NameAddressPhoneFax 
    Add a new row
    Please list a minimum of three trade references.
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  • This field is for validation purposes and should be left unchanged.

Unless otherwise amended on the Invoice, CREDIT TERMS: NET 30 DAYS

All invoices are due and payable per the terms stated on the invoice. A service charge will be assessed on all past due invoices at the rate of 1 1/2% (one and one-half percent) per month (18% per annum). If payments are not received in accordance with our terms, your account will automatically revert to COD status. The undersigned agrees to these terms and to pay any and all costs of collection for past due amounts.

THIS APPLICATION IS MADE WITH THE UNDERSTANDING AND AGREEMENT THAT ALL CHARGES FOR PARTS AND SERVICE WORK ARE DUE AND PAYABLE PER THE TERMS STATED ON THE INVOICE.

**Sales Tax Exemption Certificates should be submitted to PO Box 35650 Louisville, KY 40232, Or Fax To:  502-561-2347, Or Email to: ar@republicdiesel.com

If you have any questions about the Online Credit Application call our Credit Department at (502)561-2200 or email ar@republicdiesel.com and we will be able to answer your questions.