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