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Confidential Credit Application |
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BUSINESS
INFORMATION |
Exact Trade or Corporate Name: |
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Date: |
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Street Address: |
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Fed ID: |
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City: |
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State: |
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Zip Code: |
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Mailing Address: |
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City: |
State: |
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E-Mail Address: |
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Name of Proprietors, Partners or Officers: |
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Title: |
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Title: |
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Title: |
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Is Business A: |
Proprietorship
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Partnership
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Corporation |
In Business Since:
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Are You PA Sales Tax Exempt? |
If So, Please Fill Out Exemption Form, Print and Mail to
Zacherl Motor Truck Sales, PO Box 686, 795 Greenville Pike,
Clarion, PA 16214 Or fax to 814-226-6772, Attn: Jim
Dunsmore.
Click Here for PA Tax Exempt Form |
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Do You Require Purchase Orders? |
Do You Pay By... |
Invoice:
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Statement:
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Any Special Instructions To Expedite Payment? |
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TRADE
REFERENCES |
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Name |
Address, City, State, Zip |
Phone |
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1 |
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2 |
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3 |
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BANK
REFERENCES |
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Name |
Address, City, State, Zip |
Phone |
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1 |
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2 |
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Please Check Basis on Which You Generally Pay Bills: |
30days60days
90days |
Other
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VEHICLE
NFORMATION |
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Number of Heavy Duty Trucks: |
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Primary Truck Make:
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Number of Medium Duty Trucks: |
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Primary Truck Make:
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Number of School Buses: |
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Primary Bus Make:
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Vocation
(please check only one) |
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AEM Other |
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Landscape Service |
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Agriculture & Farm |
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Less Than Truckload Carrier |
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Allied Equipment Manufacturing |
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Maintenance Lease/Rental |
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Beverage |
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Manufacturing & Processing |
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Bus Transportation |
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Manufacturing Construction Material |
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Coal Mining & Transport |
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Mining/Quarrying |
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Common/Contract Carrier |
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Miscellaneous/Delivery |
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Construction |
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Owner / Operator |
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Dealer Export Sales |
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Petroleum & Distribution /Fuel Hauling |
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Energy/Petroleum |
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Petroleum Drilling |
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Government - Federal |
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Petroleum Geological / Geophysical |
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Government - State |
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Petroleum Services |
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Government - Local |
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Rail, Sea, and Air Transport |
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Finance Lease |
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RV / Sport |
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Fire/Rescue/Ambulance |
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Service/Refuse/Recycling |
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Food Processing |
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Towing |
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Forestry/Lumber |
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Unknown |
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Utilities / Communication |
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Van & Moving Lines |
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Wholesale / Retail |
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OUR PAYMENT TERMS |
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WE OFFER A 1% DISCOUNT ON PURCHASES PAID BY THE 15TH OF THE
MONTH FOLLOWING BILLING, AND CHARGE A 1.5%(18% ANNUAL)
FINANCE CHARGE ON PAST DUE AMOUNTS. ACCOUNTS 31 DAYS OR
MORE PAST DUE BY THE TENTH OF THE MONTH FOLLOWING BILLING
WILL HAVE CHARGE PRIVILEGES SUSPENDED. |
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SIGN &
DATE |
The information given above is true and complete.
Lender may receive from and disclose to other persons,
including credit reporting agencies, information about
Applicant's accounts and credit experience and Applicant
authorizes any person to release to Lender credit experience
and account information on Applicant. This shall be a
continuing authorization for all present and future
disclosures of account information and credit experience on
Applicant made by Lender or any person requested to release
such information to Lender. |
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Disclaimer: "Email is not
considered to be a completely secure medium for the
transmission of sensitive information. Those who email
credit application information do so at their own risk."
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