TRI-STATE TRANSPORTATION

PARTS & EQUIPMENT

1420 Stonebrook Ave, Memphis, TN 38116

901-332-7344

FAX: 901-332-2732

APPLICATION FOR CREDIT

FIRM NAME___________________________________________PHONE (       )____________________

STREET ADDRESS_______________________________________________________________________

CITY___________________________STATE___________________________ZIP____________________

MAILING ADDRESS (FOR INVOICES)________________________________________________________

CITY___________________________STATE___________________________ZIP____________________

 

PLEASE CHECK ONE: INDIVIDUAL (   )   PARTNERSHIP (   )   CORPORATION (   )

SALES TAX EXEMPTION#_______________ (IF TAX EXEMPT, PLEASE PROVIDE A COPY OF CERTIFICATE)

IF INDIVIDUAL OR PARTNERSHIP, DEBTOR’S SOCIAL SECURITY #_______________________

FOR PARTNERSHIP OR INDIVIDUAL-FULL NAME OF OWNER OR OWNERS_________________________

HOME ADDRESS____________________CITY__________________STATE_______________ZIP_______

 

TYPE OF BUSINESS_________________________________DATE STARTED________________________

 

ESTIMATED ANNUAL SALES $______________________

ESTIMATED MONTHLY PURCHASES_______________________________________________________

ARE PURCHASE ORDERS REQUIRED   YES____ NO____

 

TRADE REFERENCES

1. NAME___________________________ADDRESS______________________________________

CITY________________________STATE_________ZIP__________PHONE (   )_______________

2. NAME___________________________ADDRESS______________________________________

CITY________________________STATE_________ZIP__________PHONE (   )_______________

3. NAME___________________________ADDRESS______________________________________

CITY________________________STATE_________ZIP__________PHONE (   )_______________

4. NAME___________________________ADDRESS______________________________________

CITY________________________STATE_________ZIP__________PHONE (   )_______________

5. NAME___________________________ADDRESS______________________________________

CITY________________________STATE_________ZIP__________PHONE (   )_______________

6. NAME___________________________ADDRESS______________________________________

CITY________________________STATE_________ZIP__________PHONE (   )_______________

 

APPLICANT’S SIGNATURE ATTESTS FINANCIAL RESPONSIBILITY, ABILITY AND WILLINGNESS TO PAY OUR INVOICES ACCORDANCE WITH TERMS.

 

Use of this account constitutes an agreement that the signer and/or his principle agree to pay all collection costs, court costs, and reasonable attorney fees in the event of nonpayment of this account.

FIRM NAME____________________________________________________

SIGNATURE___________________________________DATE_____________

 

 

 

 

Tri-State Transportation

Parts & Equipment

1420 Stonebrook P.O. Box 16137

Memphis, TN 38116

Phone: (901) 332-7344 Fax: (901) 332-2732