APPLICATION FOR CREDIT

Clicking the "Submit" button will initiate the application for credit in accordance with the terms and conditions of Tampa Truck Center.

Company/Individual Information

All information will be held in the strictest of confidence.

Name of Company or Individual*

Yrs. In Business*

Corporate Street*

Corporate City*

Corporate State*

Select

Corporate Zip

Yrs. at This Address*

Corporate Phone*

Type of Business*

Corporation

Partnership

Individual / Sole Proprietor

Sales Tax Exempt*

Yes

Exemption # (if applicable)

Nature of Business*

Fed Tax ID*

Principal's Name*

Principal's Phone*

Local (Ship-To) Company Information

This information is for the local branch that we would be interfacing with.

Local (ship-to) Street*

Local (ship-to) City*

Local (ship-to) State*

Local (ship-to) Zip*

Local (ship-to) Contact Name*

Local (ship-to) Contact Email*

Local (ship-to) Contact Phone*

Accounts Payable Information

Accounts Payable Contact*

Accounts Payable email*

Email for Invoices

Amount of Credit Requested*

Purchase Order Required?*

Yes

References

A minimum 4 trade references are required. A reference sheet may be attached below if applicable. If submitting a reference sheet please enter "RS" in each of the Reference fields below.

Reference Sheet Upload

A trade reference sheet can be attached if applicable.

Drag and drop files here or

Reference 1

Name, Address, Phone and Email

Reference 2

Name, Address, Phone and Email

Reference 3

Name, Address, Phone and Email

Reference 4

Name, Address, Phone and Email

Send me a copy of my responses

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