Credit Application - Car Parts Warehouse

Legal Company Name*

Corporation
Partnership
Sole proprietor

Years in business*

DBA (If any)

Phone / Fax Number

Address

Street Address City State / Province / Region ZIP / Postal Code

Mailing Address

Same with Address
Different with Address

Mailing Address

Street Address City State ZIP Code

Principals, Owners, or Partners (Name of parent company if subsidiary)

Name

Address

Street Address City State ZIP Code

Date of Birth

Social Security Number*

Trade and Other Credit Reference

Primary Bank

Address

Street Address City State ZIP Code

Checking Acct. #

Savings Acct. #

Contact Name

Title

Phone

Trade References 1

Yes

Trade References1 Name*

Trade References1 Address*

Street Address City State ZIP Code

Trade References1 Account Number*

Trade References1 Contact*

Trade References1 Phone

Trade References 2

Yes

Trade References2 Name*

Trade References2 Address*

Street Address City State ZIP Code

Trade References2 Account Number*

Trade References2 Contact*

Trade References2 Phone*

Trade References 3

Yes

Trade References3 Name*

Trade References3 Address*

Street Address City State ZIP Code

Trade References3 Account Number*

Trade References3 Contact*

Trade References3 Phone*

Attach the most recent two years fiscal year-end statement, including balance sheet, income statement, and notes to statement.

Federal ID #

Tax Exempt

Yes
No

Please click here to download PDF.

P.O. Required

Yes
No

This credit application is given to secure open account credit. The information contained therein is correct, complete and true. In consideration of the extension of credit by seller, the undersigned does jointly and severally personally guarantee to pay and be responsible for payment of all sums, balances, and accounts due seller by buyer.

It is the responsibility of the buyer to inform the seller of any changes to personnel who are the buyers “authorized purchasing agents“. The buyer agrees to be liable for the purchase price of all items from the seller by any individual whom the buyer has designated, in writing or otherwise, to be an “authorized purchasing agent“, until such time as the seller receives a written notification from the buyer that such individual is no longer authorized to be an “authorized purchasing agent“ for the buyer. The buyer does understand that if a change of ownership or any bulk transfer is completed all outstanding balances must be paid by the original buyer, or all parts returned to seller.

I/we as applicant(s) for credit authorize you to obtain such information, personal and business, as you may require from the bank and trade references given in the above application which is furnished by me/us for the purpose of obtaining credit, and I/we certify that this application has been accurately completed and represents current data. If this application is approved and credit is extended to me by Car Parts Warehouse Inc., I/we agree to pay according to the terms of net 10 prox. I/we agreed to pay service charge at the rate of 2% per month (i.e. 24% per annum) should my/our balance exceed 30 days and pay all cost of collection including reasonable attorney's fees.

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Authorized Signature

Print Name*

Date

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