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Fleet Credit Application — Gearhead Automotive

Thank You For Considering Gearhead Automotive For Your Fleet's Service Needs. Please Complete This Application So We Can Set Up A Fleet Account. All Information Is Kept Confidential And Used Only To Assess This Application.

Business Information

Legal Business Name

Operating Name / DBA (If Different)

Business Type

A
B
C
D

Years In Business

Business Phone

Business Address

Business Email

City

Province

Postal Code

GST / Business Number

Fleet Details

Approximate Number Of Vehicles In Your Fleet

Types Of Vehicles

How Many Kilometres Do You Typically Run A Unit Before Replacing It?

A
B
C
D
E

How Many Years Do You Typically Keep A Unit In Service?

This Shapes The Maintenance We Recommend: A Unit You'll Replace At 150,000 km Needs A Different Plan Than One You'll Run To 400,000.

Estimated Monthly Service Spend

A
B
C
D
E

Billing & Authorization Contacts

Accounts Payable / Billing Contact Name

Billing Contact Phone

Billing Contact Email

Who Is Authorized To Approve Work And Charges On This Account?

Credit Requested

Amount Of Credit Requested

Trade References

Please provide two or three suppliers who currently extend your business credit.

Trade Reference 1 — Company, Contact & Phone

Trade Reference 2 — Company, Contact & Phone

Trade Reference 3 — Company, Contact & Phone

Bank Reference

Bank Name

Bank Branch / Location

Bank Contact Or Account Manager (If Known)

Terms & Authorization

Terms

Standard Account Terms: Net 30 Days. Payment Is Due Within 30 Days Of The Invoice Date. Overdue Balances Are Subject To Interest At 1.5% Per Month (18% Per Annum) On The Outstanding Amount. Gearhead Automotive Services Ltd. May Suspend Credit Privileges On Accounts Not Kept Current.

Authorization

By Submitting This Application, I Authorize Gearhead Automotive Services Ltd. To Obtain Credit Information And To Contact The References And Financial Institution Listed Above To Verify This Application. I Certify That The Information Provided Is True And Complete. I Have Read And Agree To The Standard Account Terms Above.

Acknowledgement

Applicant Full Name

Title / Position

Date

Signature

Signature
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