The undersigned
hereby submits the following information for the purpose of opening an account
with HIGHWAY EQUIPMENT & SUPPLY COMPANY: PO Box 547189, Orlando, FL 32854.
Name of business _________________________________________________________________
Billing Address ___________________________________________________________________
Shipping Address _________________________________________________________________
Phone ___________________________ Fax _______________________________
Applicant is: Sole Propietorship ______ Partnership ______ Corporation _______
Type of business: ________________________________________________________________
Sales Tax Exempt # ___________________________ Federal Tax ID # _________________________
(PLEASE ATTACH COPY OF TAX EXEMPT CARD)
Name of OWNERS, PARTNERS or CORPORATE
OFFICERS
(Please include Name, Title, and Home Address)
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
BANK REFERENCE
_________________________ __________________________________
_____________
Name Address Account #
BUSINESS REFERENCES (3)
COMPANY
ACCT # PHONE # FAX #
1._______________________________ __________________
__________________ ______________
2._______________________________ __________________
__________________ ______________
3._______________________________ __________________
__________________ ______________
Established in area since:__________
Are P.O.s required?___________
Should
it become necessary to place this account with a collection agency or attorney,
for collection, suit or other legal action, I/we hereby agree to pay all costs
of such collection, suit or other legal action, including a reasonable attorney's
fee. Applicant understands that all purchases made in one month are due net on
the 10th of the following month. Applicant further understands and agrees that
service charges of 1 1/2% per month will be added to the new balance if unpaid
one month from closing date of statement. After 30 days past due, account will
automatically become COD only.
Officer Signature ____________________________________ Date ___________________________
Please fax completed form back to (800)393-0740.
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