Credit Application Form

Firm Name:(Required)

Phone:(Required)

Address(Required)

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

Monthly Statement to be emailed to you?(Required)

Email(Required)

AP Contact:(Required)

Number of years in business:(Required)

Date business was established at current location(Required)

Do you:(Required)

NAME OF PROPERTY OWNER(Required)

BANK & ACCT#:(Required)

RESELLER PERMIT #’S

(All shipments to AZ, CA, NV or WA will be charged the appropriate sales tax unless reseller permits are provided)–Please fax a copy of your permit with this application

Please provide the following information as it applies to your company:

CORPORATION?(Required)

President:(Required)

Vice President:(Required)

Secretary:(Required)

Tax ID #:(Required)

Treasurer:(Required)

Name of parent Company if Subsidiary:(Required)

State of incorporation:(Required)

Date incorporated:(Required)

PARTNERSHIP?(Required)

Partners' name:(Required)

SS#:(Required)

Home address:(Required)

City:(Required)

State:(Required)

Zip:(Required)

Home phone:(Required)

Cell phone:(Required)

SOLE OWNER?(Required)

Owner' name:(Required)

SS#:(Required)

Home address:(Required)

City:(Required)

State:(Required)

Zip:(Required)

Home phone:(Required)

Cell phone:(Required)

APPLICATION WILL NOT BE PROCESSED IF INFORMATION IS INCOMPLETE

CREDIT REFERENCES

Please list 3 references that extend your business a line of credit. Additionally, for business that rent/lease their business property, you must include the landlord or lessor as a reference.

Business Name:(Required)

Phone(Required)

Fax:(Required)

City:(Required)

State:(Required)

Account#:(Required)

Credit Limit:(Required)

Business Name:(Required)

Phone(Required)

Fax:(Required)

City:(Required)

State:(Required)

Account#:(Required)

Credit Limit:(Required)

PERSONAL GUARANTEE

(print name) will personally guarantee any Charges made by me, my Company or any affiliates as a result of the credit extended by B & R Auto Wrecking should payment not be made according to the terms stated below.(Required)

Home Address:(Required)

City:(Required)

State:(Required)

Zip(Required)

Home phone#(Required)

Cell #(Required)

TERMS

BALANCE IS DUE IN FULL BY THE 10TH OF THE FOLLOWING MONTH FOR ALL CHARGES, OR THIRTY DAYS FROM THE DATE CHARGED.

I HEREBY AGREE TO PAY 1.5% PER MONTH SERVICE CHARGE (ANNUAL 18%) ON PAST DUE BALANCE, INCLUDING ATTORNEY'S FEES AND COURT COSTS, IF ANY ARE INCURRED TO COLLECT SAID BALANCE. ANY AND ALL APPLICANTS HEREBY WAIVES NOTICE OF ANY DEMAND AS WELL AS ANY NOTICE DEFAULT.

Printed name(Required)

Date(Required)

For the purpose of obtaining credit the Customer represents that the information provided is true, complete and correct.

MENDOZA AUTO DISMANTLING

Mendoza Auto Dismantling is known around Bakersfield for providing quality auto parts at an affordable price. Along with an extensive selection of auto parts we also buy vehicles working or non-operating.

Quick Links

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Contact Info

(661)- 833-6648

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[email protected]

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7800 South Union Ave
Bakersfield, CA 93307

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