Credit Application - COD Only

Business Name

Registered Business Address

Street Address (if different)

City

Email

Postal Code

Telephone

Fax

Date Business Established

Nature of Business
== choose one == Body Shop Rebuilder Mechanic Auto Sales Parts Supplier Auto Wrecker Other

Type of Organization
== choose one == Corporation Partnership Proprietorship

List Full Names and Titles of all Officers, Partners and Owners: 

Reference 1

Name

Position

Reference 2

Name

Position

Contacts

Accounts Payable

Parts Ordering

PST #

I agree that APT may verify credit information, including requesting reports from credit reporting agencies and hereby consent to the obtaining of such reports.