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APPLICATION FOR CREDIT
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Please
Fax Completed Application to 1-618-548-9016 |
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BUSINESS INFORMATION |
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Business
Name
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Type
of Business |
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Business
Address
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Date
Started |
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City
/ State/ Zip
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Number
of Employees |
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County
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Tax Rate
% |
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Business
Phone
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Corporation |
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Beeper/Mobile
Phone
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Proprietorship
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Fax
Number
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Partnership |
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Owner's
Full Name: |
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Driver's
License Number:
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Spouse
Name (if any) |
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Social
Security
Date Of Birth:
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Social
Date Of Birth: |
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Home
Address
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City/State/Zip
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Home Phone Number |
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VENDOR INFORMATION |
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Name Precision Truck Products, Inc. |
Representative |
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Address 2625 South Broadway |
Phone Number 1-800-358-3073 |
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City/State/Zip |
Fax Number 1-618-548-9016 |
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EQUIPMENT DESCRIPTION |
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Description |
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BUSINESS
BANK ACCOUNT |
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Bank
Name
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Phone
Number |
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Account
Number
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Contact |
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* On ALL bank accounts, please provide
copies of the LAST 3 MONTHS of your bank statements. |
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ADDITIONAL BANK: PERSONAL/BUSINESS |
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Bank
Name
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Phone
Number |
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Account
Number
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Contact |
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TRADES/DEBT/LEASE REFERENCES |
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Name |
Contact |
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Phone Number |
Account
Number |
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Name |
Contact |
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Phone Number |
Account
Number |
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COMPANIES THAT YOU MOVE HOMES FOR |
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Company |
Phone
Number |
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City/State/Zip |
Contact |
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Company |
Phone
Number |
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City/State/Zip |
Contact |
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Company |
Phone
Number |
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City/State/Zip |
Contact |
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NAME OF NEAREST LIVING RELATIVE
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Name |
Address |
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Phone Number |
City/State/Zip |
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INSURANCE INFORMATION (OPTIONAL) |
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Name of Carrier: |
Exp Date: |
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I hereby
authorize a standard credit investigation on my company, its officers
and principals. The Undersigned
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authorizes all parties contacted to release credit and financial
information requested as a part of said investigation. |
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Applicant
Signature
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Date |