Fields with an * are required.
Address
City, State, Zip Code
Berman Freightliner 83 Ashley Way Leesport, PA 19533
Phone: 610-926-2146 Email: darrylbreiner@bermanfreightliner.com Terms: Net 30
Please Check One: CorporationPartnershipIndividualLLC
Do you require PO numbers?
Are you sales tax exempt?
If yes, please send tax exemption certificate with application
Ownership Name of Principal
Finance Bank Name Bank Phone Bank Officer
Business References (established accounts)