New Customer Worksheet for Credit Customers

Use this form if you are applying for a new credit account with Protective Equipment Testing Laboratory.  All accounts created with this application are subject to NET30 terms, the conditions of which can be found at the end of the application.

Please complete this applications carefully to avoid processing delays.


Contact Information:
Responsible Party
Frequency of Testing

*Please note testing fees are different for replacement customers and non-replacement customers.

Truck Inspection
Name of Person Responsible for Truck Inspections (If Applicable)
General Information
Tax Status

Credit References

*Please note that these references will be checked prior to approving your new account.

Reference 1

Reference 2

Reference 3

Terms and Conditions

All accounts are Net 30.  Any amount that is past due will be charged a 1.5% per month finance charge, with a minimum of $5.00 per month until all debt is paid in full.  Any collection costs, attorney fees, and court expenses will be your responsibility and added to the unpaid balance.

By submitting this form, you agree that your typed signature below will have the same full legal force and effect of your handwritten signature.  Signing this agreement indicates your acceptance of the terms and conditions as stated. In addition, you authorize Protective Equipment Testing Laboratory to make any and all inquiries necessary to process this credit application.

This form will not be processed without a signature.