2181 Providence Highway  Walpole, MA 02081
P: 800.225.4808  F: 508.660.0027
Application for Credit
Business Information: (please print clearly)  Corporation  LLC  Partnership  Sole Proprietorship
Business Name: ___________________________________________ Doing Business As: ______________________________________________
Billing Address: ___________________________________________ City: ______________________ State: _____________ Zip: _____________
Shipping Address: __________________________________________City: ______________________ State: _____________ Zip: _____________
Telephone #: _________________________________Cell #: ________________________________ Fax #: ________________________________
Year Business Started: _________________________ Annual Sales: _________________________ # of Employees: _________________________
Line of Business: ______________________________________________ Federal ID #: _______________________________________________
Accounts Payable Contact: ________________________ Email Address:____________________________
Phone #: (if different than above) __________________________ Fax #: (if different than above) ________________________________
Taxable? or Non-Taxable? (if non-taxable, exempt certificate required - please include with application) PO# Required? Yes  No
Owner(s): _______________________________________________________________________________________________________________
President: ____________________________________________________ Vice President: ______________________________________________
Chief Financial Officer: _________________________________________ Other Contact: ______________________________________________
Credit References: (three trade references and one bank reference required)
Trade Reference: _________________________________________ Address: _______________________________________________________
Phone #: ______________________________ Fax #: ______________________________ Email: _______________________________________
Trade Reference: _________________________________________ Address: _______________________________________________________
Phone #: ______________________________ Fax #: ______________________________ Email: _______________________________________
Trade Reference: ________________________________________ Address: ________________________________________________________
Phone #: ______________________________ Fax #: ______________________________ Email: _______________________________________
Bank Reference: __________________________________________ Account #: _____________________________________________________
Address: ___________________________________________________________ Contact: _____________________________________________
Phone #: ____________________________________________________ Fax #: ______________________________________________________
In consideration of credit being extended by Minuteman Trucks, Inc. to the above named applicant, the undersigned guarantor(s) each contract and guarantee to Minuteman
Trucks, Inc. the faithful payment, when due, of all accounts of the applicant for the next five years from the date of application. The undersigned guarantor(s) each expressly
waive all notice of acceptance of this guarantee, notice of extension of credit to applicant, presentment or demand for payment and any notice of default by applicant and all
other notices guarantor(s) might otherwise be entitled to. Revocation of guarantee shall be in writing, and delivered by certified mail to Minuteman Trucks, Inc. at 2181
Providence Hwy., Walpole, MA 02081.
Authorized Signature: _____________________________________________ Printed Name: ______________________________________________
Credit Release Authorization - Customer Agreement - Conditions of Sale
I hereby certify that the above information is correct and I authorize the release of credit information to Minuteman Trucks, Inc. by our trade and bank references. Customer
agrees to make payment in full for all amounts due with terms. Terms are as follows: (1) net 30 days to qualified buyers upon credit approval (2) new orders may not be
shipped to accounts with past due balances (3) no deductions from invoices will be allowed without authorization from Minuteman Trucks, Inc. in writing (4) a finance charge
of 1.5% per month will be charged to past due invoices. Customer agrees to pay all reasonable costs, such as, but not limited to: court costs and attorney’s fee incurred by
Minuteman Trucks, Inc. whether or not a suit is filed.
Authorized Signature: ______________________________________________ Date: ____________________________________________________
Printed Name: ____________________________________________________ Title: ____________________________________________________
Please fax completed form to 508.660.0027 or email to [email protected]