Fleet Credit Application by Houska Automotive

FLEET CREDIT APPLICATION

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Credit Application

Business Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Contact Name *

First

Last

Primary Contact Phone Number *

Email *

Previous Repair Facility *

Reason For Leaving? *

Trade Reference 1 *

Trade Reference 2 *

Trade Reference 3 *

Requested Credit Line Amount *

Do You Use Purchase Orders? *

Yes
No

Do You Pay Sales Tax? *

Yes
No

If No, Tax ID#

Persons Authorized To Charge On Account

Preferred Statement Delivery Method *

Mail
Fax
Email

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Completed By *

Any Account With An Outstanding Balance Over 30 Days Will Be Subject To Interest Charges *

I understand

Name