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Tools and Equipment
Shop Stocking Program
Machine Shop Service
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Credit Application
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APPLICATION FOR CREDIT
WE HERE BY REQUEST THAT UNDERCAR PLUS INC. EXTEND CREDIT PRIVILEGES TO OUR COMPANY AND CERTIFY THAT THE INFORMATION PROVIDED BELOW IS CORRECT. WE AGREE TO MEET THE TERMS AND THE CONDITIONS SET FORTH BELOW IF APPROVED BY UNDERCAR PLUS INC.
DBA Name
*
HEREINAFTER REFERRED TO AS “PURCHASER"
The Company is a
*
Corporation
Partnership
Proprietorship
Exact Legal Name
*
Federal ID#
*
Shipping Address
*
Address Line 1
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Same as Shipping Address?
*
Yes
No
If Yes, bypass Billing Address.
Billing Address
Address Line 1
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Account Manager
*
Phone
*
Email
*
How Long in Business
Phone
*
Premises
Owned
Leased
Name & Address of Mortgagor OR Landlord
Are Any of Your Business Assets Pledged as Security for a Loan or Credit?
Yes
No
If Yes, Explain?
TRADE REFERENCE: (3 REQUIRED)
PLEASE COMPLETE HIGHEST MONTHLY CREDIT REFERENCES
1. Company Name
*
Contact Name
*
Phone
*
Address
Address Line 1
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
2. Company Name
*
Contact Name
*
Phone
*
Address
Address Line 1
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
3. Company Name
Contact Name
Phone
Address
Address Line 1
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
BANK INFORMATION
Bank Name
*
Type of Account
*
Checking
Savings
Account Number
Address
Address Line 1
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Contact
Phone
NAME OF OWNER, PARTNERS OF CORPORATE OFFICERS
Name
*
Phone
*
Home Address
Address Line 1
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
You Own This Property?
Yes
No
California Driver License#
*
THE UNDERSIGNED AGREES TO THE FOLLOWING TERMS AND CONDITIONS
THE UNDERSIGNED INDIVIDUALLY, IN CONSIDERATION OF “UNDERCAR PLUS INC” EXTENDING CREDIT TO “PURCHASER” DO HEREBY PERSONALLY GUARANTEE PAYMENT IN FULL TO “ UNDERCAR PLUS INC” OF ALL AMOUNTS HERE AFTER OWED TO “UNDERCAR PLUS INC.” BY “PURCHASER” AS WELL AS LEGAL FEES, SHOULD UNDERCAR PLUS INC. REFER THE ACCOUNT TO FOR COLLECTIONS. SUCH GUARANTEE IS MADE EACH TIME THAT SERVICES OR MERCHANDISE ARE ORDERED ON CREDIT FROM “UNDERCAR PLUS INC.” I (WE) HEREBY AUTHORIZE RELEASE TO UNDERCAR PLUS INC. OF ANY AND ALL INFORMATION CONCERNING EMPLOYMENT, CHECKING ACCOUNTS, SAVINGS ACCOUNTS AND INFORMATION ON ALL ORDER CREDIT MATTERS THAT MAY BE RELEVANT TO THIS APPLICATION AND AGREE THAT UNDERCAR PLUS INC. MAY VERIFY THIS INFORMATION FROM TIME TO TIME. UNDERCAR PLUS INC. RESERVES THE RIGHT TO TERMINATE OR MODIFY THE TERMS OF THE CREDIT WITHOUT FURTHER NOTICE.
Signature
*
Clear Signature
Name
*
Date
*
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