Credit Application – Pepsi Southwest Virginia

CREDIT APPLICATION REQUEST

Pepsi Southwest Virginia Application of Credit

This is an application for an open account for the purchase of product from Pepsi-Cola Bottling co. of Corbin, Inc. Your business will be applying for thirty (30) day credit and will have the ability to settle invoices using a credit card, debit card, checking account, or ACH. By filling out this form you agree that you have read and accept the terms and conditions below. Please provide all the information requested in the form below, someone from our Account Receivable Department will reach out to you with further details upon the approval of your application.

Primary Business Contact Information

Please select which Virginia county your business is located in.(Required)

Name of Primary Business Contact(Required)

First Last

Role in Company?(Required)

Phone of Primary Business Contact(Required)

Email of Primary Business Contact(Required)

Business Information

Name of Business(Required)

Current Cash Customer?(Required)

Federal Tax I.D. Number(Required)

Type of Business?(Required)

Years in Business?(Required)

Business Website or Social Media (if applicable)

Business Phone Number(Required)

Business Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

E-Sign the Contract

By typing your name in the field below and signing your digital signature you are entering into a contract with Pepsi-Cola Bottling of Corbin.

Please Type Your Full Name Below.(Required)

Signature(Required)