NEW: Parts Credit Application

PARTS/SERVICE CREDIT APPLICATION
Section 1
What type of purchases will you make each month?

PartsService
How much do you expect to purchase each month? TOTAL $:
Credit Limit Desired
How many trucks will be covered under this credit agreement?

Section 2
Legal Business Name
Trade Name (d/b/a)
Physical Address

Street Address

Street Address Line 2

CityState

Zip Code
Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone #1
Phone #2
Fax #
County
Place of Business

CommercialResidential
# of Employees
Date Business Started

Section 4
Bank Information:
Bank Name:
Address

Street Address

Street Address Line 2

CityState

Zip Code
Bank Officer:

First NameLast Name
Title:
Account #:
Checking - Avg Balance ($)
Savings - Avg Balance ($)
Loan Balance
Other Balance

Section 5
Business/Trade References (Three active business references are required)
Business Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Contact Name
Date Opened
Avg Balance
Credit Limit
Business Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number
Contact Name
Date Opened
Avg Balance
Credit Limit
Business Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Contact Name
Date Opened
Avg Balance
Credit Limit

Section 6
COMPANY NAME:
Personal References (Three people who you've known more than five years)
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Relationship
Years Known
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Relationship
Years Known
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Relationship
Years Known

SECURITY INTEREST

I {fullName26}, for and in consideration of your extending credit to the Company I represent, {legalBusiness}, herein referred to as the "Company", hereby grant Freightliner of St. Cloud a security interest in all assets purchased by the Company. I understand that, by signing this document, I am obligating the Company to agree that Freightliner of St. Cloud is authorized and permitted to file a UCC financing statement and a valid security interest against all assets that are purchased by the Company. Indicated by my signature below, I agree to grant Freightliner of St. Cloud a security interest in exchange for the financing of purchases by Freightliner of St. Cloud.
Signature

Clear
Date:
PERSONAL GUARANTEE

I {fullName26}, for and in consideration of your extending credit to the Company I represent, {legalBusiness}, herein referred to as teh "Company", hereby PERSONALLY GUARANTEE payment to Freightliner of St. Cloud at St. Cloud, Minnesota, of any obligation of the Company for all purchases including service work, body work, and parts billed to the Company, and I hereby bind myself to pay to you on demand any such sum due to you by the Company whenever the Company shall fail to pay the said sum. It is understood that this guarantee shall be a continuing and irrevocable guarantee and indemnity for such indebtedness of the Company. NOTE: I do hereby waive notice of default and nonpayment and notice thereof and consent to any modification or renewal of the credit agreement hereby guaranteed. In the event it becomes necessary to place this account for collection, I agree to be liable for the costs of collection, including legal and accounting fees, court costs and disbursements; to be subject to the laws of the state of Minnesota: and that the venue shall be Stearns County, Minnesota.
Signature

Clear
Date:
I hereby acknowledge that I am an officer, principal or owner of the Entity described in Section 2 and this application is being made with the understanding and agreement that credit terms are Net 30 days. All credit purchases will be subject to a Late Charge of 1 1/2% per Month (18% Annual Percentage Rate) if not paid within 30 days of invoice date. In the event this account goes to collections, I agree to be liable for the costs of collection, including legal and accounting fees, court costs and disbursements, and that the venue shall be Stearns County, Minnesota. Freightliner of St. Cloud retains the right to limit the amount of credit extended. I hereby authorize Freightliner of St. Cloud to obtain the necessary credit information to substaintiate the credit application. (Note: All information will be handled in a cinfidential manner.)
Print Name:
Signature

Clear
Date:
Should be Empty:

PARTS/SERVICE CREDIT APPLICATION