STS Truck and Trailer Equipment > Credit Application

Credit Application

* Required Fields

Company Information

* Firm Name:
Bill to Address 1
Bill to Address 2
County:
* City:
* State:
* Zip:
* Phone:
Fax:
Business is:
Other:

Tax & Purchase Information

Will purchase from STS be Taxable? Yes No
Indicate applicable state or local tax rate:

Credit limit requested:

Do you require a purchase order? Yes No

Name of Principal of Business

Name 1:
Title 1:
Address1:
Name 2:
Title 2:
Address2:

Financial Information

Type of Business:
Approx. Net Worth
Number of Employees:

Bank Name
Bank Address 1:
Bank Address 2:
Bank Phone:
Contact Person:

Trade References

Business Name 1:
Phone:
Fax:
Address:

Business Name 2:
Phone:
Fax:
Address:

Business Name 3:
Phone:
Fax:
Address:

Business Name 4:
Phone:
Fax:
Address:

Digital Signature

I agree to attest the financial responsibility, ability and willingness to pay our invoices in accordance with the terms and authorize investigation of all statements contained in this application concerning credit histories. I undersand the payment terms are specified by an invoice service charge of 1% per month on all overdue balances (balances will include any prior unpaid service charges). I understand overdue accounts may be referred to an attorney for collection and if suit is commenced, I agree to pay reasonable attorney's fees.

I also hereby certify that I am authorized to submit this form and that the information is true and correct. I further understand that a typed version of my name is being accepted as my original signature pursuant to the Federal Electronic Signature Act.

I Agree I Disagree

* Name:
* Title: