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LOS ANGELES FREIGHTLINER (DOC download)

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					                                                                   Los Angeles Freightliner        BusWest
                                                                   San Diego Freightliner          Refuse Parts & Maintenance
                                                                   South Bay Truck Center          FleetLogic
                                                                   SelecTrucks of L.A. & L.V.      Crossroads Equipment Lease & Finance
                                                                   Silver State Truck & Trailer    High Desert Truck & Trailer
                                                                   Performance Truck & Trailer     TransWest Truck Center
                                                                                                    www.VelocityVehicleGroup.com


CREDIT APPLICATION FOR OPEN PARTS AND SERVICE ACCOUNT                                    PART & SERVICE           RENTAL                 LEASE
 INDIVIDUAL                     PARTNERSHIP               CORPORATION                   Year Business Started _____________             Listed in D&B? YES  NO 
NAME                                                                          DBA                                                                   PHONE #
                                                                                                                                                    FAX #
BILLING ADDRESS                                                               CITY                       COUNTY      TAX RATE             STATE               ZIP



                                                        Name and Home Addresses of Individuals, Partners or Corporate Officers
NAME                                          ADDRESS                                   CITY                      STATE           ZIP             PHONE #




PHYSICAL LOCATION OF BUSINESS               STREET ____________________________          CITY __________________________ STATE _______ ZIP ______________

TYPE OF BUSINESS _______________________ # OF TRUCKS OWNED ________ HAVE YOU PURCHASED A TRUCK FROM L.A. FREIGHTLINER?                      YES       NO 

RESALE           YES    NO      IF YES, PLEASE ATTACH RESALE CARD. FED I.D. # ___ ___ -- ___ ___ ___ ___ ___ ___ ___      NEW                  USED 
                                           COMPLETE, SIGNED & DATED
                                                                                    RESALE # ______________________________
BILLING INFORMATION
P.O. Required?      YES           NO             Authorized Purchasing Agent ___________________________                Accts. Payable Contact ____________________________
                                                                                                                          Accts. Payable Ph. # _________________ Ext. _________
(IF YOU CHECKED “INDIVIDUAL” ABOVE, THE FOLLOWING “MUST” BE COMPLETED)
NAME OF EMPLOYER                    ADDRESS                                   CITY                       STATE            ZIP           PHONE #



YOUR S.S # _________--_________--_________                              DATE OF BIRTH ____________________________                        SPOUSE’S FIRST INITIAL _______
FORM 3 101-CA                                                                        (GO TO NEXT PAGE)
       REVISED 7/04                                                                                                                                                     PAGE 1 of 2
                           PLEASE FILL OUT THIS SECTION AS COMPLETE AS POSSIBLE WITH COMPLETE ADDRESSES AND ZIP CODES

Banking Information:
CHECKING:
BANK                             ADDRESS                           CITY     STATE          ZIP             ACCOUNT #                        PHONE



SAVINGS:
BANK                             ADDRESS                           CITY     STATE          ZIP             ACCOUNT #                        PHONE



UNSECURED Credit References (Open account – Minimum 3)
NAME                                       ADDRESS                                  CITY                   STATE            ZIP          PHONE # / FAX #
                                                                                                                                         PH. #
                                                                                                                                         FAX #
                                                                                                                                         PH. #
                                                                                                                                         FAX #
                                                                                                                                         PH. #
                                                                                                                                         FAX #
                                                                                                                                        PH. #
                                                                                                                                         FAX #

SECURED Credit References Accounts Where Collateral is HELD by the Lender
NAME                                       ADDRESS                                  CITY                   STATE            ZIP          PHONE # / FAX #




READ BEFORE SIGNING:
    I have completed this Credit Application for the purpose of procuring and maintaining credit on an open account basis with LOS ANGELES FREIGHTLINER, and certify
that all statements are true. I authorized LOS ANGELES FREIGHTLINER, to check credit references and to verify employment. I also authorized LOS ANGELES
FREIGHTLINER to provide credit information arising from these transactions to others.
    I understand and agree that all charges are due and payable 30 days following the date of charge. Credit cards won’t be accepted as form of payment on open
account. In the event it becomes necessary for our company to incur collection costs or institute suit to collect costs or institute suit to collect any amount due under this
agreement, the undersigned promises to pay such additional costs, interest, including reasonable attorney’s fees. We have the right to terminate this agreement and or
limit the amount of credit extended.
I, ___________________________________ AUTHORIZE LOS ANGELES FREIGHTLINER, TO ACCESS MY CREDIT REPORT FOR CREDIT PURPOSES. THIS APPROVAL WILL
ALLOW LOS ANGELES FREIGHTLINER TO UTILIZE CREDIT REPORTING AGENCIES TO OBTAIN CREDIT APPRROVAL AND ANY FOLLOW-UP REPORTS FOR CREDIT PURPOSES.
By _________________________________________________________________ DATE ________________________

SIGNED _________________________________________________________ TITLE __________________________________ DATE _________________________
FORM 3 101-CA
REVISED 7/04                                                                                                                                                         PAGE 2of 2

				
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posted:11/12/2011
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