APPLICATION FOR ACCOUNT - PARTS OR SERVICE
Contact Information |
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Name / Trade Name |
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Address |
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City |
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Postal Code |
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Phone |
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Fax |
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Contact |
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Name of Principles |
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Title |
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Name of Principles |
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Title |
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Social Security Number |
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Numbers of Years in Business |
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Truck #'s |
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Type of Firm: |
Partnership
Proprietorship
Corporation |
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Anticipated Monthly Purchases: |
$ |
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P.S.T. Exempt # |
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G.S.T. Exempt # |
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BANKING INFORMATION |
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Bank Name |
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Contact |
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Address |
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Account Number |
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Phone Number / Area Code |
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TRADE REFERANCES |
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1 |
Company Name
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Contact / Phone Number
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Address
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2 |
Company Name
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Contact / Phone Number
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Address
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3 |
Company Name
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Contact / Phone Number
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Address
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If credit is extended to you, who is authorized to charge on your beha lf ? |
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AUTHORIZATION AND DATE |
CONSENT: I (we) hereby authorize Eastgate Truck Centre 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 Eastgate Truck Centre. in collection of any past due amounts |
Application Date
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Signed By:
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Print your name here:
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Your E-Mail Address
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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. |
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The information you are submitting is not encrypted. |
