Credit Application Form

Company Name :   

Address :               Unit # :

Postal / Zip Code : 

Telephone :            Fax : 

Please fax me more information!

-Select- Mr. Mrs. Ms. Contact Name :  

E-mail :               

Please indicate which best describes your business.  Car Dealership Garage Fleet Other
Additional Information : 

Incorporated Sole Proprietorship

How long in business : 

How long at the above address : 

Previous address if less than 2 years : 

Number of vehicles in your fleet : 

Bank Name : 

Branch (indicate # or main intersection): 

Account # : 

Contact : 

Principal(s) Information

1.

-Select- Mr. Mrs. Ms.    First Name :    Last Name : 

Title :

-Select- Mr. Mrs. Ms.    First Name :    Last Name : 

Title :

-Select- Mr. Mrs. Ms.    First Name :    Last Name : 

Title :

Suppliers Information

1.

Company Name :   

Address :               Unit # :

Postal / Zip Code : 

Telephone :            Fax : 

-Select- Mr. Mrs. Ms. Contact Name :  

2.

Company Name :   

Address :               Unit # :

Postal / Zip Code : 

Telephone :            Fax : 

-Select- Mr. Mrs. Ms. Contact Name :  

3.

Company Name :   

Address :               Unit # :

Postal / Zip Code : 

Telephone :            Fax : 

-Select- Mr. Mrs. Ms. Contact Name :  

Additional Comments:

Name :   

Address :               Unit # :

Postal / Zip Code : 

Telephone :            Fax : 

Towing Rates :           P/U Charge

KLMS :            Dollies :

Flatbed :            Light Service :

Service Advisor :            No. of Bills to :

After Hrs. Instr. :            Do you issue P.O.'s : Yes    No

Contact Person :            Billing :