Confidential Credit Application

Please fill in the form below.

Asterisk indicates Required Field

Business Information

  • Exact or Corporate Name
  • Fed ID
  • Date

Address

  • Street Address
    *
  • Street Address Line 2
  • City
    *
  • State / Province
    *
  • Postal / Zip Code
    *
  • Country
    *

 

  • Mailing Address
  • City
  • State

 

  • Phone
    *
  • Fax
  • Email
    *

 

  • Name of Proprietors, Partners, or Officers
  • Title
  • Name of Proprietors, Partners, or Officers
  • Title
  • Name of Proprietors, Partners, or Officers
  • Title

 

  • Business Type
    Partnership Corporation Proprietorship
  • In Business Since
  • Is Business PA Sales Tax Exempt?
    Yes No

If so, Please fill out the Exemption Form Available Here. You may also email the tax exempt form to info@zacherlmotors.com.

 

  • Do You Require Purchase Orders
    Yes No
  • Do You Pay By
    Invoice Statement
  • Any Special Instructions to Expedite Payment

Trade References

  • Name
  • Address
  • Phone
  • Fax
  • Name
  • Address
  • Phone
  • Fax
  • Name
  • Address
  • Phone
  • Fax

Bank References

  • Name
  • Address
  • Phone
  • Name
  • Address
  • Phone
  • Basis on Which You Generally Pay Bills
    30 Days 60 Days 90 Days Other

Vehicle Information

  • Number of Heavy Duty trucks
  • Number of Medium Duty Trucks
  • Number of School Buses
  • Primary Make of Trucks / Buses

Vocation

  • Please Check Only One
    AEM Other Agriculture & Farm Allied Equipment Manufacturing Bus Transportation Coal Mining & Transport Common/Contract Carrier Construction Dealer Export Sales Energy / Petroleum Government - Federal Government - State Government - Local Finance Lease Fire/Rescue/Ambulance Food Processing Forestry/Lumber Utilities / Communication Wholesale / Retail Landscape Service Less Than Truckload Carrier Maintenance Lease/Rental Manufacturing & Processing Manufacturing Construction Material Mining / Quarrying Miscellaneous Delivery Owner / Operator Petroleum & Distibution / Fuel Hauling Petroleum Drilling Petrolium Geological / Geophysical Petrolium Services Rail, Sea, and Air Transport RV / Sport Service / Refuse / Recycling Towing Unknown Van & Moving Lines

Other Payment Terms

WE OFFER A 1% DISCOUNT ON PURCHASES PAID BY THE 15TH OF THE MONTH FOLLOWING BILLING, AND CHARGE A 1.5%(18% ANNUAL) FINANCE CHARGE ON PAST DUE AMOUNTS. ACCOUNTS 31 DAYS OR MORE PAST DUE BY THE TENTH OF THE MONTH FOLLOWING BILLING WILL HAVE CHARGE PRIVILEGES SUSPENDED.

Sign and Date

The information given above is true and complete. Lender may receive from and disclose to other persons, including credit reporting agencies, information about Applicant's accounts and credit experience and Applicant authorizes any person to release to Lender credit experience and account information on Applicant. This shall be a continuing authorization for all present and future disclosures of account information and credit experience on Applicant made by Lender or any person requested to release such information to Lender.

  • Signed By
  • Title
  • Date
  • Email

Disclaimer: "Email is not considered to be a completely secure medium for the transmission of sensitive information. Those who email credit application information do so at their own risk."