Credit Application

Credit Application Form

"*" indicates required fields

Business Information

Business Name*

Phone*

Business Email*

Fax

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Nature of Business*

Type of Business*

Annual Sales*

Number of Employees*

Number of Trips Required (annually) & Expected Frequency*

GST Number*

Limit Requested*

Preferred Method of Payment*

Other Method of Payment

Purchase Orders Required/Issued*

Yes

*Note, invoices are set to send via email, please request alternate arrangements if necessary.

Special Instructions

Contact Information

KEY CONTACT PERSONS

Contact Person 1*

First Last

Title*

Phone*

Email*

Contact Person 2

First Last

Title

Phone

PRINCIPAL(S) / OFFICERS(S) / – (NAME / TITLE / % OWNERSHIP)

Name

First Name Last Name

Title

Ownership

Name

First Name Last Name

Title

Ownership

Name

First Name Last Name

Title

Ownership

References

BANK REFERENCE

Bank Name*

Account No.*

Branch Phone Number*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

BUSINESS REFERENCES

Reference 1*

Contact Name*

Email*

Phone*

Reference 2*

Contact Name*

Email*

Phone*

Agreement

Full Name for Agreement*

agreement

By selecting this box you agree with the terms and conditions listed below; that you have answered all the questions above to the best of your knowledge; and that Astro Towing will use this information to process your credit application.

Terms are net 30 days subject to credit approval. Overdue accounts are subject to interest charges of 2% per month (24% per annum). After 90 days, accounts may be placed for collections and reported to credit bureaus.
Invoicing discrepancies must be reported in writing within 72 hours after receipt.
Permission is granted for above-named references to release my credit information to Astro Towing.
Astro Towing shall not be liable for loss, damage, or delay caused by acts of God, terrorism, public authorities, strikes, labor disputes, weather, mechanical failures, or civil commotions

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Credit Application

Simplify your business with a credit account.

Credit Application Form

Business Information

Contact Information

References

Agreement