MONTHLY CREDIT APPLICATION

MONTHLY CREDIT APPLICATION
APPLICANT INFORMATION
Legal Company Name*
Address*

Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Cell*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Manager’s Name
Manager's Phone
Please enter a valid phone number.Format: (000) 000-0000.
Manager's Email
example@example.com
Owner's Name
Owner’s Phone
Please enter a valid phone number.Format: (000) 000-0000.
Owner's Address

Owners' Address

Street Address Line 2

CityState / Province

Postal / Zip Code
CorporationProprietorship
Number of Years in Business*
Credit Limit Requested*
G.S.T. Number*
YesNo
Accounts Payable Contact: Name
Accounts Payable Contact: Email
example@example.com
Statement Delivery Email*
example@example.com
If “Vehicle Repairs,” please specify:
How many service bays do you have
How many full-time employees do you have
If “Fleet Maintenance,” please specify:
How many vehicles are in your inventory
Auto Value Barlow SE - #155 3953 112 Ave SEAuto Value Country Hills - 170 11358 Barlow Trail NEAuto Value Crowfoot - #4 250 Crowfoot Crescent NWAuto Value Forest Lawn - 5140 Hubalta Road SEAuto Value Macleod Trail - #123 8228 Macleod Trail SEAuto Value Midnapore - 5150 Bannister Road SE)Auto Value 16th Ave - 616 16 Ave NWAuto Value 17th Ave SW - 3821B 17 Ave SWAuto Value 32nd Ave NE - 1633 32 Ave NECentral Auto Parts Distributors (Main Warehouse) - 34 Highfield Circle SEAuto Value Airdrie - #103 1300 Market StreetAuto Value Drumheller - 300 South Railway Ave EAuto Value Lethbridge - 1707 3 Ave SAuto Value Red Deer - 6870 Gaetz Ave
WEEKLY ACCOUNT
Please Supply 3 Business References:
Name of Reference*
Reference #1
Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Name of Reference*
Reference #2
Phone #*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Name of Reference*
Reference #3
Phone #*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Credit Card Information (Optional):

You will receive a call from our accounting department at 403-259-8658 to confirm your card number
Card Number
Expiry Month
Expiry Year
CVC
Name of Card Holder
Monthly Account Terms & Conditions:
- All invoices are due Net 10 (10th day of the month following the statement date).
- Past due balances will incur a 2% monthly fee (24% per year
- Accepted payment methods: cheque, EFT, e-transfer, cash, or credit card.
- Failure to pay the statement balance by the due date will result in the account being placed on stop.
- A $1.00 fee per document applies for each duplicate statement, invoice, credit note, or record of account (ROA) requested.
- Accounts with no activity for 24 months will be closed.
- Any changes to ownership, partnership, or business structure affecting credit arrangements must be reported in writing.
- Central Auto Parts Distributors Ltd. may update these terms at any time, without notice. Continued use of services implies acceptance of updated terms.
I hereby certify that the information provided in this application is true and complete and is submitted for the purpose of obtaining goods on credit. I authorize Central Auto Parts Distributors Ltd. and its authorized representatives to contact the references listed herein to verify my credit history and financial standing. I further authorize Central Auto Parts Distributors Ltd., or its authorized representatives, to charge the credit card provided for the monthly outstanding balance on my account, if payment has not been made by other means.
Signature*
Name*
Title*
Signing officer of the company
Date*

MonthDayYear
Date
Please verify that you are human*
INTERNAL USE
Account Number
Set-up Date

MonthDayYear
Date
Approved By
Special Pricing
Sales Representative
Credit Limit
Account Approved By
Date Approved

MonthDayYear
Date
Should be Empty:

MONTHLY CREDIT APPLICATION

APPLICANT INFORMATION

WEEKLY ACCOUNT

Please Supply 3 Business References:

Credit Card Information (Optional):

Monthly Account Terms & Conditions:

INTERNAL USE