Credit Application

To complete the Online Credit Application, please fill out the form below. If you’d prefer to download the application, please click here.

All invoices are due and payable per the terms stated on the invoice. A service charge will be assessed on all past due invoices at the rate of 1.5% (one and one-half percent) per month (18% per annum). If payments are not received in accordance with our terms, your account will automatically revert to COD status. The undersigned agrees to these terms and to pay any and all costs of collection for past due amounts.

This application is made with the understanding and agreement that all charges for parts and service work are due and payable per the terms stated on the invoice.

Sales Tax Exemption Certificates should be submitted to

PO Box 35650
Louisville, KY 40232

Fax:  502-561-2347
Email: ar@republicdiesel.com

If you have any questions about the Online Credit Application, call our Credit Department at (502)561-2200 or email ar@republicdiesel.com and we will be able to answer your questions.

Credit Application Form

Step 1 of 2

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  • If billing address is the same as shipping address, leave blank.
  • Ex.: www.yourwebsite.com