Business Credit Reports

Company Information

Company Name

DBA

Address

City

State/Province

Zip/Postal Code

Country

Phone

Tax Identification #

# of Years in Business

Legal Form (Corporation, Partnership, or Proprietorship)

Fax

Contact Information

First Name

Last Name

Phone

Fax

Bank References

Bank

Phone

Contact

Address

City

State

Zip

Fax

Principals #1

Name

Address

City

State

Zip

Phone

Principals #2

Name

Address

City

State

Zip

Phone

Principals #3

Name

Address

City

State

Zip

Phone

Major Trade Reference #1

Name

Address

City

State

Zip

Contact Name

Contact Phone

Fax

Major Trade Reference #2

Name

Address

City

State

Zip

Contact Name

Contact Phone

Fax

Major Trade Reference #3

Name

Address

City

State

Zip

Contact Name

Contact Phone

Fax

General Info

How many vehicles in your fleet?

Types of vehicles/equipment?

Do you require a PO? (Yes or No)

Who makes the purchasing decisions? (Name)

Title

Contact #

Request

Requested Amount

Comments (400 characters max)

Terms

Application may take up to 14 days for processing. Upon acceptance and Approval, credit terms will be Net 30. Statements are mailed monthly and payment in full is required per terms.
The undersigned agrees to notify American Tire Company within ten days of changes in names, address, ownership, or legal entity.
ACKNOWLEDGEMENT OF RESPONSIBILITY: IN ORDER TO INDUCE AMERICAN TIRE COMPANY TO PROVIDE CREDIT TO THE ABOVE-NAMED FIRM, AND IN CONSIDERATION OF SUCH CREDIT BEING EXTENDED, THE ABOVE-NAMED FIRM AGREES THAT IN THE EVENT CREDIT IS ISSUED PURSUANT TO THIS APPLICATION IS NOT PRE-PAID IN ACCORDANCE WITH THE ABOVE-REFERENCED PAYMENT TERMS, THE ABOVE-NAMED FIRM AGREES TO REIMBURSE AMERICAN TIRE COMPANY FOR ALL COSTS, EXPENSES, CHARGES, AND FEES EXPENDED BY AMERICAN TIRE COMPANY IN EFFECTING COLLECTION, INCLUDING BY WAY OF COLLECTION AGENT'S FEES, ATTORNEY'S FEES, FILING FEES, ETC.
The information has been provided with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. I hereby authorize the financial institutions listed in this credit application to release necessary information to the company to which credit is being applied for in order to verify the information contained herein.
I hereby certify that the information contained herein is complete and accurate and we agree to all of American Tire Company's payment and terms and conditions.

I accept the above terms.

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Submit the Request

By clicking 'Submit', I/We authorize American Tire Company or its agent to obtain a credit report for the purpose of establishing, maintaining or enforcing a credit relationship. Upon approval of credit, I/We agree to pay our account according to the terms granted and I/We acknowledge that I/We have read and fully understand this application.

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