Application for Account

APPLICATION FOR ACCOUNT - PARTS OR SERVICE Contact Information
Name / Trade Name
Address
City		Postal Code
Phone		Fax
Contact
Name of Principles		Title
Name of Principles		Title
Social Security Number
Numbers of Years in Business		Truck #'s
Type of Firm:	Partnership Proprietorship Corporation
Anticipated Monthly Purchases:	$
P.S.T. Exempt #
G.S.T. Exempt #
BANKING INFORMATION
Bank Name
Contact
Address
Account Number
Phone Number / Area Code
TRADE REFERANCES
1	Company Name
	Contact / Phone Number
	Address

2	Company Name
	Contact / Phone Number
	Address

3	Company Name
	Contact / Phone Number
	Address

If credit is extended to you, who is authorized to charge on your beha lf ?
AUTHORIZATION AND DATE
CONSENT: I (we) hereby authorize Equipment Search Demonstration System to obtain credit or other information as may be deemed necessary in connection with the establishment and maintenance of a credit account or for any other direct business required. I (we) ( Company Name ) understand that accounts in arrears are subjectto a service charge at a rate of 1 1/2 % per month on outstanding balances in excess of 30 days. Accounts not paid within 30 days are considered past due and may cause interruption in credit extended. I further agree to pay collection and / or legal fees incurred by Equipment Search Demonstration System. in collection of any past due amounts
Application Date	Signed By:
Print your name here:	Your E-Mail Address
Enter todays date : 2008-7-19 - - We need to ask you this, to prevent spam-bots from flooding our Dealers in-boxes. Please use the exact yyyy-mm-dd format.

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