NEW CUSTOMER CREDIT APPLICATION
NEW CUSTOMER CREDIT APPLICATION
Welcome!
We're so excited to begin our partnership with you! To ensure we have the information we need to best serve you, please take a few minutes to fill out the form below. If you have any questions, please feel free to contact us at any time. Thank you!
Company Information
Company Name
DBA
Federal Tax ID#
State Tax ID#
Number of Years in Business
Type of Business
Please provide information regarding owners, partners or officers of this company
Name
Title
Social Security #
Billing Address
Shipping Address
Phone
Fax
Company Website
Contact Information
PURCHASING CONTACT
Name
Phone Number
Email
Purchase Order Required
ACCOUNTS PAYABLE CONTACT
Name
Phone Number
Email
OTHER CONTACT
Name
Phone Number
Email
Bank Reference
Name of Bank
Account Number
Address
Bank Contact
Contact Phone #
Contact Fax #
Trade References
1. COMPANY NAME
ACCOUNT #
ADDRESS
FAX #
CITY
STATE
ZIP CODE
2. COMPANY NAME
ACCOUNT #
ADDRESS
FAX #
CITY
STATE
ZIP CODE
3. COMPANY NAME
ACCOUNT #
ADDRESS
FAX #
CITY
STATE
ZIP CODE
4. COMPANY NAME
ACCOUNT #
ADDRESS
FAX #
CITY
STATE
ZIP CODE
5. COMPANY NAME
ACCOUNT #
ADDRESS
FAX #
CITY
STATE
ZIP CODE
Current Lug Nut Supplier
Current TPMS Supplier
Monthly Acc purchase volume
**THIS APPLICATION MUST BE READ AND SIGNED BY AN OWNER OR OFFICER OF THE COMPANY. BY SIGNING THIS APPLICATION YOU AGREE TO ALLOW REVOLUTION SUPPLY TO CHECK CREDIT WITH THE ABOVE REFERENCES**
Signature
Title
Printed Name
Date
REVOLUTION SUPPLY CO. INC.
2901 W. MacArthur Blvd #110, Santa Ana, CA 92704
PHONE (714) 891-0100    FAX (714) 902-9669
[email protected]