Dealer Inquiry – Stock Cents Farm Equipment

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Your Name *

First

Last

Your Phone

Your Email *

Your Title

Company Name

Company Address

Address Line 1

Address Line 2

City

State

Zip Code

Company Phone

Years at current location

Selected Value: 0

Months at current location

Selected Value: 0

Type of Company

Section Divider

Bank Name

Bank Contact

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Account Type

References

Please provide three business references.

Reference 1

Company Name

Contact Name *

First

Last

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Comments

Reference 2

Company Name

Contact Name *

First

Last

Phone

Comments

Reference 3

Company Name

Contact Name *

First

Last

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Comments

I agree

All payments must be postmarked within 30 days of the date on the invoice. All invoices will be sent via email. Any claims regarding an invoice issued must be made within 7 days of the date issued. You authorize inquiry into the banking and business references provided within this application.

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