Dynamometer Account Activation
Legal Business Name
 Dunn & Bradstreet# (if applicable)
Billing Address
 Number of Years in Business
City
 State
 Zip
 Phone
 Fax
Contact Name
 Email  
Owner/President Name
 Federal Tax ID Number
Are You: If Other, List: State of Corporation
Shipping Information
Street Address
City
 State
 Zip
Other Information
Dynamometer Model
Serial #
Website
Do you wish to be listed on our website's Dynamometer locator listing?
Winpep Version
 A/F
 Eddy Current
 4WD Dynamometer
Company Name / Person from which the Dynamometer was purchased
Terms are NET COD or credit card. These terms are subject to change upon investigation of provided trade references. Any invoice over the agreed terms will be considered delinquent. When the account is delinquent, the entire balance of the account becomes due and payable. In the event of default, you agree to pay all collection charges, court costs and attorney fees. No additional deliveries will be made when an account is delinquent.
I have read and accept the terms and conditions as stated on this application.
Authorized Signature
 Date
Title