Poorman Auto Supply Credit Application

Apply for credit with Poorman Auto Supply. Fill out the credit application form below and tax exempt form here or follow our 5 easy steps.

  1. Download our Credit Application.
  2. Print the application.
  3. Fill in all the fields on the application to the best of your ability.
  4. Please also download and complete the Tax Exempt form, if you are wanting no tax on your account.
  5. Fax your completed form(s) to our main location at 316-265-2381.

Once we receive and review your application, we will be in touch to get your account set up.

If you have any questions regarding our application process please contact us for assistance.

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Credit Application

Billing Address*
Shipping Address
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Trade References

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