Download
a PDF version of our credit application and
fax us a completed copy.
I understand that with this open account I will have
30 days to pay. A 2% discount is allowed on merchandise
if payment is made within 10 days from date of delivery.
Any invoice not paid in full within 30 days will be
past due and subject to a finance charge of 1.5% (18%
annually)
Inoicing
Information
Company:
Contact Name:
Billing Address:
Telephone:
City:
Fax Number:
State:
E-mail:
Zip Code:
Website:
Account No.:
Business
Information and References
Please
list three (3) other companies with which
you already have open account privileges.
We will be contacting these businesses to
evaluate your creditworthiness. By completing
this form you are authorizing us to contact
these businesses. All information gathered
will remain confidential.
Company Name
City
State
Zip
Phone
Fax
1
2
3
About
Your Business
Type
of Business: (select one)
Corporation
Partnership
Proprietorship
Owner's Full Name
SSN
Title
Ownership %
Residence Address
1
2
3
Additional
Information
Purchase
Orders: Do you require the use of purchase
order numbers?
Yes
No
Ship-To
Address: (if different from Bill-to)
Address:
City:
State:
Zip:
State
Sales & Use Tax Exemption:
I hold a Valid Seller's Permit. Contact "Support" for the
appropriate form.
Please
tell us a little about your business. This
won't affect your credit application, but
will help us better tailor our product line
to fit our customers' needs.
Optional
Information:
Nature of Business:
Number of Employees:
Number of Mechanics:
Year Business Started:
Legal
Stuff:
I
certify the the information I have provided
is true and accurate. I understand that
this is a legally binding credit application
and that legal action may be taken if I
have misrepresented myself or my credit
history in any way.
Enter your name here to agree with the above
statement:
