Quality Truck Care Center, Inc. Business Credit Application



Company Name :
Address :
City :	State :
Zip-Code :	Phone :

Fed ID# :	Incorporated :	Yes : No :
What state are you incorparoated in :
Line of Business :
Years in Business :
Parent Company :
Street Address :
City :	State :
Zip-Code :	Phone :

If Business is sole proprietorship or partnership, list full names of proprietor or partners...
Name :	Title :
Name :	Title :
Purchase orders required :	Yes : No :
Approved By :	E-Mail :

Two credit references regarding parts & service purchasses...
Name :	Phone :
Address :
Name of contact :
Name :	Phone :
Address :
Name of contact :

Bank Reference...
Bank :	Account # :
Address :
Name of Contact :	Phone :

Applicant acknowledges and accepts the following credit terms: Payment is due by the 10th of the month following the invoice date. A finance charge of 1.5% per month (18% annaul percentage) will apply to any unpaid past due balance.
Applicant's Signature :	Title :	Date :
Approval :	Title :	Date :