Des Moines Flying Service

Credit Application

* asterisk denotes required information


*Contact Name
*Name of firm or Individual
*Address
*City
*State/Province
*Zip / Postal Code
*Phone
*Fax
*Years at this Address

Terms

Normally, Net 30 EOM


Ownership

Corporation
Partnership
Individual

Incorporated within the past 12 months?

*Name of principals
*Complete Address *City *State *Zip *Phone
Name of principals
Complete Address City State Zip Phone

Finance

*Bank
*Address
*City
*State
*Zip
*Phone
*Department or Officer

References

(3 required)

*Business Name
*Complete Address *City *State *Zip *Phone
*Business Name
*Complete Address *City *State *Zip *Phone
*Business Name
*Complete Address *City *State *Zip *Phone
Business Name
Complete Address City State Zip Phone

Check here if credit card or COD is okay until terms are established.

We certify that all the information on this form is correct. We fully understand your credit terms and agree to the proper payment in consideration of extended credit.

*Date
*Submitted by
*(Title)

Contact Us

800-247-2560
515-256-5300
f: 515-256-5555

Email

JoAnn Fife
Parts Manager
Keith Mullen
Parts Supervisor
Bob Kain
Parts Sales
John Nizzi
Shipping and Receiving
Carolyn Harkin
Warranty Administrator

If you do not wish to complete this form online, you may print it out and fax to (515) 256-5555, attention Credit Department

Des Moines Flying Service Chicago Piper