Applicant Information
Name of firm or individual
Shipping Address     City     State     Zip
Billing Address     City     State     Zip
Telephone number     Fax
800 Phone number
Sales Tax Number     Are P.O.'s required    yes    no
What type of business     Business started mm/yyyy
Tax I.D. number     Contact person

If partnership or sole proprietor
Name     Social Security #
Home address     City     State     Zip
Telephone number     Total years in business
   
Name     Social Security #
Home address     City     State     Zip
Telephone number     Total years in business

If corporation full names of officers
President
Vice President
Sectretary
Treasurer
How long at this business address

Buildings
Buying     Owned     Leasing

Person(s) authorized to charge
1.
2.
3.

Referances
1.
2.
3.

*If credit is established, it is fully understood that all accounts are due in full by the 10th of the month following purchases. Also understood that any account not paid in full by the following 10th will be placed on hold until paid in full. By checking the box below and filling out the full name, you will accept responsibility for all credit charges made to your company.

I/We understand the terms and accept responsibility for all credit charges made to our company.
  Name
  Title     Date mm/dd/yyyy

 

         
*required fields

 
Shaheen Chevrolet - 632 American Road Lansing, Michigan, USA 48911
Copyright 2005 by Shaheen Chevrolet, All rights reserved.