Hans'Freightliner Credit Application

Our Credit Policy is net 30 days. Statements are mailed at the beginning the new month

Full Name:

Shipping Address:

Billing Address: ...

Phone:

Email:

Are you tax exempt?

Trade References (you must have 3 in order to apply for an open account)

Company Name:

Phone #:

Fax#:

Address:

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Company Name:

Phone #:

Fax#:

Address:

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Company Name:

Phone #:

Fax#:

Address:

I agree that the above information is correct to the best of my knowledge. I also agree to pay within 30 days for services rendered, and understand that all accounts that reach 45 days will be put on COD.

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