Business Credit Application

Business Credit Application
568 State Highway 166 • Cooperstown, NY 13326 • Phone/Fax: 607-286-7322
Text 607-383-0772 • www.wahltowahlauto.com • sales@wtwap.net
Company Name:
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Fax Number
Contact Email:
example@example.com
Billing Email:
example@example.com
Type of Business:
Form of Business:

CorporatedL.L.C.PartnershipSole OwnerOther
Tax ID
Upload Tax Documents

Cancelof
References (3)

Name, Phone, Email, etc.
Reference 1 Business
Reference 1 Contact

First NameLast Name
Reference 1 Phone/Email
(###) ###-#### or email@domain.com
Reference 2 Business
Reference 2 Contact

First NameLast Name
Reference 2 Phone/Email
(###) ###-#### or email@domain.com
Reference 3 Business
Reference 3 Contact

First NameLast Name
Reference 3 Phone/Email
(###) ###-#### or email@domain.com
Amount Requested
Amount Being Requested
Let us know how much you'd like to have available to charge
Personal Guarantee by:
Name
Phone Number
Signature

Clear
As a valued customer we are extending credit to your business in faith that all payments will be made within 30 days of original purchase. Interest will occur after 30 days. We reserve right to turn off credit line at any time. Payments can be mailed to the above address or credit card on our website. (https://billpay.wtwap.net/ & https://www.wahltowahlauto.com/). By signing below you are ensuring as much. We thank you for your business.
Print
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

References (3)

Personal Guarantee by: