Credit Application - Print this page and fax to the above #
Company Name:_______________________________________________________________

Type Of Business:______________________________________________________________

Address:_____________________________________________________________________

Postal Code:________________________________ Phone/Fax #:________________________

Major Credit Card #___________________________ Expiry Date:________________________

Name Of Card Holder:___________________________________________________________

Credit References
Co. Name:___________________________________ Phone #:__________________________

Address:___________________________________ Contact:____________________________

Co. Name:_____________________________________ Phone #:________________________

Address:_____________________________________ Contact:___________________________

Co. Name:___________________________________ Phone #:___________________________

Address:____________________________________ Contact:___________________________

Number Of Company Vehicles TO Be Serviced Per Week:________________________________

Name Of Person Applying For Credit:________________________________________________

Position In Company:____________________________________________________________

Home Address:_________________________________________________________________

Phone #:______________________________________________________________________

Authorized Signature:____________________________ Date:_____________________________
All Accounts are due 30 Days From The Date Of Service.
**All information is kept confidential.**