New Account Register

If you already Have an account with PBS and are only looking to sign up for online access to view your invoices / Purchase your parts online / pay balance with CC or ACH. Click Here to Register for online access to your Existing account.

Complete the form below or Download the New Customer form and if applicable - Tax Exemption - and email completed documents to ar@pbstruckparts.com

New Account Company Info:

What Type of Account are you Looking For? *

Primary Store you Will Purchase from?

Company Name

Billing Address

City / State / Zip

Office / AP Contact Name

Office / AP Phone

Office / AP Email

AP Options. Select box if Yes<br>

Would you like Statements Emailed?

Would you like Invoices Emailed?

Are Purchased Orders Required?

Will purchases be tax Exempt?*

If tax Exempt, Please upload valid tax exemption form

(Leave blank if Same as above)

Purchasing Contact

Purchasing Email

Purchasing Phone

Would you like to Receive our Monthly flyer via email?

(Leave Blank if Same as Billing)

Shipping Address

Shipping City / State / Zip

Please List any Additional Ship To Location Addresses

Requested Credit Limit (In Dollars)

Business Establishment Date

Has the Company or any principal owner filed bankruptcy in the last 7 years?

Federal Tax ID

Parent Company (If Applicable)

Principal Stock Holders

Principal Address / City / State

Principal Phone / Email

Credit Reference # 1 - Company / Contact / Phone / Email

Credit Reference # 2 - Company / Contact / Phone / Email

Credit Reference # 3 - Company / Contact / Phone / Email

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