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"

Credit Application

Owner – Partners – Officers

Bank Reference

Please Provide 3 to 5 Trade References

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"

Simple modal box

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"