Dealer Credit Application

Company Name______________________________________________________________
Name of Corporate offices______________________________________________________
Location of Corporate offices_____________________________State_____Zip__________
Subsidiary or Division of_______________________________________________________
Billing Address_________________________City___________State_______Zip_________
Shipping Address___________________________City________State_____Zip__________
Contact Person________________________Phone Number of Contact_________________
Corporation: Yes__ No___ DBA: Yes__No__ Partnership(LLC): Yes___No___ Other:___
State Incorporated in:_________________________ Years of establishment____________
Previous business address if has not been at current address for at least 3years
Street address_______________________State__________ Zip code__________________
Number of employees _________________________________________________________
Annual Sales for last business year______________________________________________
Type of business_____________________________________________________________
Names and Titles of officers 1.__________________________________________________
2.__________________________________________________
3.__________________________________________________
4.__________________________________________________
Home address of CEO/ President/ Owner Street:___________________________________
State_________________________________ Zip code______________________________
Name(s) of employees who are authorized to make purchases on this account
1.____________________________________________________________
2.____________________________________________________________

3.____________________________________________________________
4.____________________________________________________________

Company Bank:______________________________ Phone Number:__________________

Checking account estimated balance $___________________ Savings $______________
Address of Bank:________________________City______________State____Zip________
Loan account Numbers______________________ Release Numbers__________________

Three credit references with whom you or above company currently has credit
established with in good standing.
Name_______________________________________________________________________
Phone Number__________________________________ Contact Name_________________
Address____________________________________________State_______Zip___________

Name_______________________________________________________________________
Phone Number__________________________________Contact Name_________________
Address____________________________________________State_______Zip___________

Name_______________________________________________________________________
Phone Number__________________________________Contact Name_________________
Address____________________________________________State_______Zip___________

Credit Application created by:________________________________________(print name)

________________________________________(signature)
Date:_________/___________/_____________

By completing this credit application you are not guaranteed credit by any dealer or group of dealers, each dealer within Foothills Wholesale Parts
reserves the right to issue or deny credit. All dealers may terminate credit at any time in the event they feel the need arises. All establishments who are issued
credit will be expected to pay their account in a NET 30 term. In the event your accounts are not kept up to date Foothills and or their dealers will reserver the
rights to contact you about the outstanding balance and make all future parts purchases through cash or check only basis. Foothills Wholesale Parts does not
issue credit for any dealer. Foothills will keep a copy of this credit application on file electronically and will email a pdf of it to all dealers we are currently doing
business with for ease of establishing credit with many different vendors with the use of only one application. This application is to be used only by dealers who
are a part of the Foothills Wholesale Parts program, in the event the application is used by dealers outside of our program foothills wholesale parts reserves the
right to contact and charge said dealer for the use of our programs and products. For any further information or concerns contact Keith at Foothills Wholesale
Parts 828-320-6889.

Email Completed PDF to keith@foothillswholesaleparts.com

Foothills Wholesale Parts
P.O. Box 422
Conover, NC, 28613
www.foothillswholesaleparts.com
828-320-6889