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Credit Application

If you prefer to not complete the form on-line. We have provided a link where you will find a downloadable/printable version.

Credit Application

Complete the form to apply for credit.

Billing Name:
Tax ID Number:
Type of Business:
ProprietorshipPartnershipCorporationOther
If "Other" Type of Business:
Email:
Length of Time Doing Business Under Present Name:
PO Number Required:
YesNo
Billing Address:
Shipping Address:
Length of Time doing Business at Current Address:
Phone:
Toll Free:
Fax:

 

Owner - Partners - Officers

Name:
Title:
Address:
Business Phone:
Home Phone:
Name:
Title:
Address:
Business Phone:
Home Phone:

 

Bank Reference

Name:
Account Number:
Address:
Officer:
Phone:

 

Please Provide 3 to 5 Trade References

Name:
Credit Years:
Address:
Phone:
Name:
Credit Years:
Address:
Phone:
Name:
Credit Years:
Address:
Phone:
Name:
Credit Years:
Address:
Phone:
Name:
Credit Years:
Address:
Phone:

 

Our terms are Net 30. Accounts past due 60 days will be placed on C.O.D. By checking "I Understand" you are agreeing to our terms and authorize Hi-Way Auto, Inc to check Trade and/or Bank References.

"I Understand"