Salt City Truck Wash New Account Request Form

Apply for a New Account

Setting up a billing account with Salt City Truck Wash is simple...please complete the form below and we will contact you with approval.

* indicates required field

NEW ACCOUNT WORKSHEET
Company Name *
Bill To Address *
City *
State *
Zip *
Contact *
Phone *
Fax
Email Address *
Alternate Contact
Purchase Order (P.O.) Required? *	Yes	No
Statements/Billing Frequency *	Weekly	Monthly

Other Info

Note: Statements are sent out either weekly or monthly and are due upon receipt. The drivers Truck#, Trailer#, Name, and Last Commodity will be on each invoice. Please make note above if there is additional information needed on the invoice.