CREDIT APPLICATION

Choose the STTC location you are/will be working with *
SelectAberdeen, MDAlbany, NYAltoona, PAAuburn, MAAvenel, NJBaltimore, MDBethlehem, PABloomfiled, CTBridgewater, MABronx, NYCapitol Heights, MDChambersburg, PACroydon, PAEdison, NJFlanders, NJFrederick, MDFredericksburg, VAHagerstown, MDHarrisburg, PAHarrisonburg, VAJessup, PALancaster, PALansdale, PALewisberry, PAManassas, VAMarlboro, NYMifflinville, PAMilford, DEMillville, NJMilton, PAMyerstown, PANew Castle, DEPeabody, MAPottsville, PAReading, PARichmond, VASeaford, DESyrause, NYTannersville, PAToms River, NJTowanda, PAWaldorf, MDWest Chester, PAWestminster, MDWhite Marsh, MDWillingboro, NJWinchester, VAYork, PA

Company Name

Name of Owner or Officer of Corporation *

Street Address*

Mailing Address*

City*

State*
SelectAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip*

Contact Person *

Phone *

A/P Manager Name *

Fax *

Email Address of Purchaser *

Type of Business *
corporationpartnershipproprietorship

FED EIN#

SS#

SS#

Year Business Started *

Credit Line Requested *

Total Vehicles *

Tractors *

Trailers *

Straight Trucks *

Other *

Are you exempt from PA, NJ, MD, NY, or VA sales tax? *
YesNo

Bank References

Bank Name *

Contact *

Account # *

Phone *

Local Trade References (Include Name, Address, Phone Number, Fax Number)
Reference 1

Name

Address

Phone Number

Fax Number

Account Number

Type of Business

Reference 2

Name

Address

Phone Number

Fax Number

Account Number

Type of Business

Reference 3

Name

Address

Phone Number

Fax Number

Account Number

Type of Business

Billing Requirements

Is a purchase order required? *
YesNo

Are you exempt from Federal Excise Tax? *
YesNo

STTC distributes monthly statements via fax or email.
Please enter fax number or email address to which statements should be sent:

Fax:

Email:

Are you National Account? If YES, please enter your account number below. *
YesNo

Michelin Account Number

Goodyear Account Number

Yokohama Account Number

List any special billing requirements:

Authorization
I hereby authorize Service Tire Truck Centers, Inc. or any Credit Bureau employed by Service Tire Truck Centers to investigate the references herein listed. If I do not pay the sums due within the agreed-upon terms, I agree to pay, in addition to sums, a finance charge of 1.5% per month on the net overdue amounts, plus 40% of the principal balance for the purpose of legal and collection fees if necessary.

Name of Authorized Representative of Company *

Title of Authorized Representative of Company *

Date *