Credit Application

Name of Firm or Individual

Address

City

State

ZIP

Website

E-Mail Address

FAX

Social Security No. or Federal I.D No.

Years in Business

Years at this address

Phone #

Tax Exempt?

HEREBY applies for credit in accordance with the terms and conditions of Truck Equipment, Inc.

The following information must be provided. It will be held in the strictest of confidence

OWNERSHIP

Names of Principal

Complete Address

ZIP

Phone

FAX

Names of Principal

Complete Address

ZIP

Phone

FAX

BANKING INFORMATION

Bank

Bank Address

Bank Officer or Department

Email

FAX

TRADE/CREDIT REFERENCES

Reference #1

Company Name

Complete Address

ZIP

Contact Person

Phone

E-Mail Address

FAX

Reference #2

Company Name

Complete Address

ZIP

Contact Person

Phone

E-Mail Address

FAX

Reference #3

Company Name

Complete Address

ZIP

Contact Person

Phone

E-Mail Address

FAX

Reference #4

Company Name

Complete Address

ZIP

Contact Person

Phone

E-Mail Address

FAX




We certify that all the information on this form is correct. We fully understand your credit terms and agree to the proper payment in consideration of extended credit. I hereby authorize the above references and bank to release credit information to Truck Equipment Inc.


(Signed)

Date

Title




COMPLETE IF TAX EXEMPT

Wisconsin Department of Revenue
Income, Sales, Inheritance & Excise Tax Division
Post Office Box 8903
Madison, Wisconsin 53708

CERTIFICATE OF EXEMPTION

 

The undersigned hereby claims exemption on the purchase, lease or rental of tangible personal property or taxable service form.


(Name of Seller or Lessor)


Based upon his or her proposed exempt use of the item purchased or the exempt status of the purchasing institution as shown below.

If “continuous” exemption is checked above, this certificate shall continue in force until revoked and shall be considered as part of each order given to the above named seller or lessor. Use of this certificate does not exempt sales of taxable items for uses other than certified above. Misuse of this certificate by the seller, lessor, buyer, lessee, or other representative may constitute a misdemeanor.

Purchaser's Business Name

Authorized Signature

Purchaser's Address

Title

Date

Purchaser's or Lessee's Business Activity (e.g. Grocer, Utility, Trucker, etc.)

This form is not to be used by farmers, or manufacturers purchasing machinery and equipment; they should use the exemption forms designed for their use.

Sellers must retain this form as a part of their records.
This Form May Be Reproduced

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