Truck Centers, Inc. | Credit Applications

To: Truck Centers, Inc.

The undersigned hereby consent to Truck Centers, Inc. use of a non-business consumer credit report on the undersigned in order to further evaluate the credit worthiness of the undersigned as principal, proprietor and/or guarantor in connection with the extension of business credit as contemplated by this credit application. The undersigned hereby authorizes Truck Centers, Inc. to utilize a consumer credit report on the undersigned from time to time in connection with the extension or continuation of the business credit represented by this credit application. The undersigned as an individual hereby knowingly consent to the use of such credit report consistent with the Federal Fair Credit Reporting Act as contained in 15 U.S.C. @1681 et seq.

This application is submitted by the undersigned for the purpose of obtaining a parts and service credit account with Truck Centers Inc. I certify that all the information on this form is correct and that credit terms set forth are understood and acceptable. This is NOT a revolving charge account. No terms or conditions of purchase orders different from the terms of Truck Centers will become part of any sales agreement, purchase order or other document. Credit terms are as specified on each invoice. Late payments are subject to a late payment penalty of 1.5% per month on any such delinquent debt or the maximum rate permissible by law (whichever is lower).

In consideration of personal benefits accruing to me, I guarantee payment of all correct charges to the business and if for any reason the account is not paid when due, I will pay it. If, after delinquency, Applicant’s account is referred to an attorney or collection agency, Applicant/Guarantor agrees to pay reasonable charges incurred by Truck Centers, Inc., including collection agency and/or attorney fees and court costs.

I hereby authorize our bank(s) and credit references to release credit information to Truck Centers, Inc. for the purpose of credit evaluation.

General Information
Locations to Serve You… (Please check locations you will utilize)	Illinois
	Mt. Vernon	Troy	Springfield	Morton	Decatur	Morris

	Missouri
	St. Louis
Estimate of Total Purchases per month	$
Firm or Individual Name:
Email Address:
Mailing / Billing Address: (Street, City, State, Zip Code)
Ship to / Deliver Address: (Street, City, State, Zip Code)
Telephone Numbers:	Home
	Shop
	Cell
	Fax No.
Is the business a:	Corporation		Partnership		Sole Proprietorship
Operates from:	Residence		Shop		Office
# of Trucks:
Years in Business:
Federal ID Number:
Haul for / Lease to:	Company Name		Address		Phone Number (Include Area Code)

How long?
Person to contact regarding Accounts Payable				Phone:

Principal’s Information
Name:
Position:
SSN:
Home Phone:
Home Address:
City:
State:
Zip:

Do you have a spouse?	Yes No
Spouse's Name:
Place of Employment:
SSN:
Phone Number:

Credit References (Need 4 References) [FILL IN ALL INFORMATION]

Name	Address	Phone	Account Number		Balance




Bank Name / Address:		Savings		Checking

Billing Information

Taxable?	Yes	No
If NO - List ICC No. or Resale No.
Require PO No.	Yes	No
Payment Reference:	By invoice (Due 30 days from invoice date)	By statement (Due 10th of the Month)