Online Credit Application - Johnson Towers

ONLINE CREDIT APPLICATION

Step 1 of 3

GENERAL INFORMATION
Name Of Company*
DBA
Billing Address
City
State
Zip
Shipping Address*
City
State
Zip
Telephone No.*
Fax No.
Line Of Credit Requested
E Mail Address*

COMPANY BACKGROUND
Type Of Business
SS OR EIN #
No. Of Years In Business
Years Under Present Mgmt.
Are P.O.'s Required?
- Yes
- No
Type Of Company:
- Proprietorship
- Partnership
- Corporation
Tax Status
- Taxable
- Exempt
Owners, Partners Or Corporate Officers
Name
Address
City
State
Zip
Name
Address
City
State
Zip
Name
Address
City
State
Zip
A/P Contact
Name
Phone No.
Fax No.
Shop Contact
Name
Phone No.
Fax No.
Purch. Agent
Name
Phone No.
Fax No.
The undersigned Customer ("Customer") hereby makes application for the extension of commercial credit to finance the purchase of certain motor vehicles from Johnson & Towers. Customer authorizes Johnson & Towers to forward this application, together with any supplemental materials submitted by Customer, to others for consideration of credit extension. Johnson & Towers may receive from and disclose to others, including credit reporting agencies, information about the applicant's accounts and credit experience. Applicant authorizes such others to release to Johnson & Towers credit experience and account information regarding applicant. This shall be a continuing authorization for all present and future disclosures of account information and credit experience on applicant made by Johnson & Towers or any person requested to release such information to Johnson & Towers. Customer represents and warrants that the information disclosed herein, along with any and all supplemental information, including financial statements, tax returns, and balance sheets, are accurate and complete. Customer will provide immediate notice in writing to Johnson & Towers if and when any material changes occur in this information. --- Customer authorizes release of all banking and credit information, both business and personal requested by Johnson Corporation: (Johnson & Towers Inc, Johnson Truck Center, LLC, Dovell & Williams). This form may be reproduced or photocopied and a fax copy shall be effective consent as the original which i have signed. Terms: Net-30 days unless otherwise stated. We reserve the right to charge 1 ½% per month (18% per annum) interest on all past-due accounts. In the event that it becomes necessary to place this account with an attorney for collection, undersigned agrees to be liable for said cost, including court costs and attorney fees.*
- I agree to Johnson & Towers Credit Application Agreement
Signature*
Phone
This field is for validation purposes and should be left unchanged.