Customer on Boarding

Date

Month

Day

Year

Business Name:

Phone:

Contact Name

Contact's Phone:

Multi-line address

Country/Region

Address

City

Zip / Postal code

Business Type:

Year Established

Ownership Structure:

Owner's First and Last Name

Title

Monthly Anticipated Purchases $

Person in Accounts Payable

Names of Owners, Partners, or Corporate Officers

Name

Title

Phone

First Name

Title

Phone

First Name

Title

Phone

Three credit refrences are required for all new customers

References

Phone

Address

References

Phone

Address

References

Phone

Address

The following MUST be signed by an Owner or Corporate Officer: SRC Automotive, Inc. Payment terms are NET 30 Days from Invoice Date unless otherwise agreed to. All unpaid invoices past 30 day terms will be subject to a monthly late payment charge equal to 1.5% of the invoice amount plus any accured but unpaid late payment charges. By signing this credit application, I acknowledge and accept these terms.

Signature

Date picker

File upload

Attach Tax-Exempt Form or other documentations.

Customer on Boarding

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