Credit Application for Parts and Service

Basic Information

Legal Name:
Address:	(include your city, state, zip)
Billing Address: (if different)	(include your city, state, zip)
Contact:		ICC #:
Phone:		Federal Tax ID #:
Fax:		Yrs in Business:
Organization Type:	Corporation Partnership Proprietorship

Owner's Name	Title	Social Security #	% of Ownership

Bank and Financing Information

Bank Name:		Customer Since:
Contact:		Credit Line:
Phone #:		Current Balance:
Fax #:

Trade Reference 1		Trade Reference 2
Name:		Name:
Phone #:		Phone #:
Fax #:		Fax #
Trade Reference 3		Trade Reference 4
Name:		Name:
Phone #:		Phone #:
Fax #:		Fax #

To: Fleetco, Inc. and their Assigns.

I certify that the information stated in this profile is true and correct to the best of my knowledge and is provided for the purpose of obtaining credit. I understand that you will retain this information whether or not I am approved for credit. You are hereby authorized to check my credit, obtain insurance information and answer questions about your credit experience with me. I authorize you to contact my creditors and authorize any creditor contacted to release to you such credit information as you may request.