Credit Application Form

Credit Application Form

NAPA Auto Supply
Company Information
Name:*
Business Name
DBA (if different):
Doing Business As
Phone Number*
Please enter a valid phone number.
Fax
Please enter a valid fax number.
Email*
example@example.com
Federal Tax ID # or Social Security #*
Type of Company*

CorporationPartnershipLimited Liability CompanySole ProprietorOther
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
State Where Incorporated*
How Long in Business*
Years and Months
Ownership Information
Please complete the below information for all officers, owners, members, and partners.*
Are you applying for a Cash Account?*
Bank Reference
Name of Bank*
Phone*
Please enter a valid phone number.
Bank Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Name*

First NameLast Name
Account Number*
Type of Account*
Personal Guarantee
In consideration of any credit extended, the undersigned will personally guarantee full and prompt payment of all indebtedness of Enter Name incurred for merchandise provided by ASEC INC. Inc. This personal guarantee shall remain in force until its revocation is acknowledged in writing by Enter Name* . Revocation shall not affect indebtedness incurred prior to receipt of written notice.
Individual Signature

Clear
Date*

MonthDayYear
Date
Name

First NameLast Name
Social Security Number
Purchasing Information
Does your company use written purchase orders?*
If yes, can purchase(s) be made without written purchase orders at time of purchase?*
Is there a list of persons authorized to charge on this account?*
List of Authorized Persons*
Purchasing Contact

First NameLast Name
Phone Number
Please enter a valid phone number.
A/R Contact

First NameLast Name
Phone Number
Please enter a valid phone number.
Tax Information

South Carolina Tax Commission Sales and Use Tax Division
ASEC Inc. (DBA NAPA Auto Supply & Equipment Co. Inc.)
Name of Seller

PO Box 30638 Charleston, SC 29407
Address of Seller

Pursuant to the provisions of section 12-35-630, Code of Laws of South Carolina, 1976, the undersigned certifies that the tangible personal property purchased from the above named seller was purchased for resale.
Trade or purchaser's Business*
South Carolina resale license #*
Trade or purchaser's Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of business operated*
Date*

MonthDayYear
Signature*

Clear
Print name of Purchaser*
Should be Empty:

Credit Application Form

Company Information

Ownership Information

Bank Reference

Personal Guarantee

Purchasing Information

Tax Information

ASEC Inc. (DBA NAPA Auto Supply & Equipment Co. Inc.)
Name of Seller

PO Box 30638 Charleston, SC 29407
Address of Seller

Credit Application Form

Company Information

Ownership Information

Bank Reference

Personal Guarantee

Purchasing Information

Tax Information

ASEC Inc. (DBA NAPA Auto Supply & Equipment Co. Inc.)Name of Seller

PO Box 30638 Charleston, SC 29407Address of Seller

ASEC Inc. (DBA NAPA Auto Supply & Equipment Co. Inc.)
Name of Seller

PO Box 30638 Charleston, SC 29407
Address of Seller