BROWN AUTOMOTIVE GROUP

OPEN TRADE ACCOUNT

CREDIT APPLICATION

 Legal Name:________________________________________________________________

CORPORATION________  PARTNERSHIP__________ SELF EMPLOYED_______

DBA, if any_________________________________________________________________

Billing Address: ________________________________City:________ State:___ ZIP:_____

Shipping Address: ______________________________ City:________ State:___ ZIP:_____

Business Phone #:_________________ Fax #:_________________

E-Mail Address:_____________________________________________________________

Banking Information:  Bank Name:_____________________________________________

Branch Address:_________________________________________

Branch Phone #:__________________________________________

Federal Tax ID#:_____________________________________________________________

State Sales Tax#:_____________________________________________________________

Purchase Orders Required: YES/NO_______________________

Authorized Signers:  Printed Name Signature

_________________________ _______________________

_________________________ _______________________

_________________________ _______________________

Person Completing Application:_________________________________________________

Date:_____________________ 

CREDIT REFERENCES

1: Business Name:_______________________________ Contact:_____________________

Address:______________________________________ City:________ State:___ ZIP:_____

Phone#:_______________________________________ Fax#:________________________

2: Business Name:_______________________________ Contact:_____________________

Address:______________________________________ City:________ State:___ ZIP:_____

Phone#:_______________________________________ Fax#:________________________

3: Business Name:_______________________________ Contact:_____________________

Address:______________________________________ City:________ State:___ ZIP:_____

Phone#:_______________________________________ Fax#:________________________