APPLICATION FOR ACCOUNT - PARTS OR SERVICE
Contact Information |
| Name / Trade Name |
|
| Address |
|
| City |
|
Postal Code |
|
| Phone |
|
Fax |
|
| Contact |
|
| Name of Principles |
|
Title |
|
| Name of Principles |
|
Title |
|
| Social Security Number |
|
| Numbers of Years in Business |
|
Truck #'s |
|
| Type of Firm: |
Partnership
Proprietorship
Corporation |
| Anticipated Monthly Purchases: |
$ |
| P.S.T. Exempt # |
|
| G.S.T. Exempt # |
|
| BANKING INFORMATION |
| Bank Name |
|
| Contact |
|
| Address |
|
| Account Number |
|
| Phone Number / Area Code |
|
| TRADE REFERANCES |
| 1 |
Company Name
|
|
Contact / Phone Number
|
|
Address
|
|
| 2 |
Company Name
|
|
Contact / Phone Number
|
|
Address
|
|
| 3 |
Company Name
|
|
Contact / Phone Number
|
|
Address
|
|
| If credit is extended to you, who is authorized to charge on your beha lf ? |
|
| AUTHORIZATION AND DATE |
CONSENT: I (we) hereby authorize Plainsview Trailer Sales to obtain credit or other information as may be deemed necessary in connection with the establishment and maintenance of a credit account or for any other direct business required.
I (we) ( Company Name ) understand that accounts in arrears are subjectto a service charge at a rate of 1 1/2 % per month on outstanding balances in excess of 30 days. Accounts not paid within 30 days are considered past due and may cause interruption in credit extended. I further agree to pay collection and / or legal fees incurred by Plainsview Trailer Sales. in collection of any past due amounts |
Application Date
|
Signed By:
|
Print your name here:
|
Your E-Mail Address
|
Enter Today's Date : (2010/01/31)--
We need to ask you this, to prevent spam-bots from flooding our Dealers in-boxes. Please use the exact yyyy-mm-dd format.
|
|
|
The information you are submitting is not encrypted. |