Date
Business Name
Business Address
Owner's Name
Owners Address
Phone
Fax
Social Security #
FEIN#
Contact Person(s)
Type of Business
Purchase Order Required
Yes
No
Are You Exempt From Sales Tax?
Yes
Exception #
Which Individuals are Authorized to Charge on Your Account
REFERENCES: (INCLUDE BANK AND 3 TRADES)
Bank, Fax#, Contact
Trade 1, Fax#, Contact
Trade 2, Fax#, Contact
Trade 3, Fax#, Contact
This application is made with the understanding and agreement that all charges for service work are due and payable by the 10th of the month following the month of charge. All accounts that have not been paid by the 25th of the month following the month of charge will pay a finance charge of 1.5% per annum. If any a mount exceeds 60 days the account will be replaced on COD permanently. Should this account need to be placed for collection you agree to all costs and fees including collection and attorney fees. The undersigned understands the terms of prompt wrecker service and will personally guarantee payment for all charges made on this account.
Signed
Print Name
Title
Submit
Should be Empty: