Please print, fill out and bring this application to any of our three Colorado Locations

Pride Auto Care #1         Pride Auto Care #2        Pride Auto Care #3

8080 S. Broadway                   8787 E. Dry Creek Rd.           11133 S. Dransfeldt Rd.
Littleton, CO 80122                Centennial, CO 80112            Parker, CO 80134
Phone: (303) 794-5545            Phone: (303) 220-0249            Phone: (303) 805-2430
Fax: (303) 798-6045                Fax: (303) 220-8492                Fax: (303) 805-4969

CREDIT INFORMATION

Please Print Legibly or Type

 

Company Name:                                                                                                            Date:                                  

Address:                                                                                                                                                                     

City:                                                                                        State:                     Zip:                                        

 

Billing Address (If different from above)                                                                                                                                                

City:                                                                        State:                                                                      Zip:                                        

Telephone                                                                Alternate Telephone                                               
Fax                                         

Description of Business:                                         D&B #:                                                                  
Dated Established:                 

Type of Entity: (Please Circle One)          Proprietorship          Partnership           Corporation            Other                      

State of Incorporation:                                                     

Year of Incorporation:                                                           

Name of Owner or Owners (or Authorized Officer of Company):                                                                                                                                                                                                                                                                                                             

TRADE REFERENCES

 

1.) Name:                                                                              Address:                                                                                                                

Telephone:                                                                    Fax:                                 Account #:                          

2.) Name:                                                                              Address:                                                                                                                

Telephone:                                                                     Fax:                              Account #:                          

3.) Name:                                                                              Address:                                                                                                                

Telephone:                                                                      Fax:                             Account #:                          

BANKING INFORMATION

Bank:                                                                     Address:                                                                                                              

Telephone:                                                            Account #:                                            Checking ___  Loan___ Other___

The information above is provided for the purpose of extending credit to our company on your terms of Net 30 .  To the best of
our knowledge, the information provided here is accurate and may be relied upon in making your credit decision. 
We authorize our bank and suppliers to furnish you any information necessary to complete your evaluation of our credit history. 
By signing below, we also agree to abide by your payment terms of Net 30, if and when a credit account is granted by Pride Auto Care. 

Signature:                                                                              Title:                                                                       Date:                     


CREDIT APPROVAL or DENIAL
(For Internal Use Only)

Established Credit Limit:                                                  

Established Credit Terms: Net 30

If credit amount is more than $5000.00 or terms exceed 30 days, please provide and explanation below.

Explanation:

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________   

Fleet Approval:

Authorized Signature:                                                                                                         Date:                                         

 

Any Credit Limit over $5,000.00 or Terms exceeding Net 30 must have Operations Manager approval.

 

Operations Manager Approval:

Authorized Signature:                                                                                    Date:                                                 

 

cc            File