Credit application

DAYTONA WRECKER  SERVICE
628 RAILWAY ST. DAYTONA BEACH FL. 32114
PHONE (386) 255-7800 FAX (386) 255-5858

CREDIT APPLICATION

THIS CREDIT APPLICATION WILL NOT BE PROCESSED UNTIL COMPLETED IN FULL

 

GENERAL INFORMATION 

 
BUSINESS  CORPORATIONPARTNERSHIPPROPRIETORSHIP
 NAME OF BUSINESS:  
  OFFICE 
 ADDRESS:  
 CITY:  
 STATE:  
 ZIP:  
 PHONE:  
 FAX:  
 EMAIL:  
 OWNER/PRESIDENT:  
 GENERAL MANAGER:  
 PARTNER (S) IF ANY:  
 TRADE INFORMATION (LIST ONLY THOSE VENDORS THAT SELL TO YOU ON OPEN ACCOUNTS) 
   
 NAME, ACCT# ADDRESS, CITY, STATE, ZIP, FAX#:  
 NAME, ACCT#, ADDRESS, CITY, STATE, ZIP, FAX#:  
 NAME, ACCT#, ADDRESS, CITY, STATE, ZIP, FAX#:  
BANKING INFORMATION   
TYPE OF ACCOUNT (S)   SAVINGSCHECKINGLOAN
 BANK NAME, ACCOUNT#, ADDRESS, PHONE, CITY, STATE, ZIP:  
VENDOR INFORMATION   
 IF ENTITLED TO TAX EXEMPT STATUS LIST TAX# AND FAX COPY OF TAX CERTIFICATE TO OUR OFFICE:  
DOES YOUR BUISNESS REQUIRE PURCHASE ORDERS?   YESNO
  LIST NAME (S) OF PERSON (S) AUTHORIZED TO PURCHASE FOR YOUR BUSINESS
 NAME, TITLE:  
 NAME, TITLE:  
 NAME, TITLE:  
 Security Code: *   

TERMS AND CONDITIONS 
ALL EQUIPMENT AND/OR PARTS SHALL REMAIN THE PROPERTY OF DAYTONA WRECKER SERVICE UNTIL FULL PAYMENT IS RECIEVED.
ALL INVOICES ARE DUE ON THE 10TH OF THE MONTH FOLLOWING PURCHASE.
ANY INVOICE PAST DUE SIXTY (60) DAYS SHALL ACCRUE A FINANCE CHARGE OF 1.5% PER MONTH (18% PER ANNUM) ON THE PAST DUE AMOUNT.
IN THE EVENT OF DEFAULT, THE BUYER AGREES TO PAY ALL REASONABLE COLLECTION AND ATTORNEY FEES, INCLUDING COURT COSTS.