New applicatio Form


    Tax I.D. Number (Copy of StateIssued Tax ID Must be Submitt

    Company Information

    Bank Refference

    Trade References

    Customer certifies that the above stated information is true and correct as of the date of this application, and agrees to update this information when changes occur. Customer further understands and agrees that invoicing, billing, and payment terms on customer account will be as per the terms set forth in each order/invoice. Customer will be responsible for all cost Parkland Collection incurs in collection of any delinquent account, including legal fees. Customer authorizes Parkland Collection LLC. to obtain information regarding their respective credit, as permitted by law, for this credit application or future credit applications, and to retain this information on file.

    Shipping Information

    Order Information

    Invoice Information

    Credit Card Information

    I, from , hereby authorize Parkland Collection LLC to charge my credit card account for purchases and incidental shipping charges or charges back billed to Parkland Collection. I authorize Parkland Collection to keep this card on file for all future purchases or order-related incidentals mentioned above.

    Shopping Cart