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H&H Auto Parts Wholesale

12860 Muscatine St., Arleta, Ca. 91331  (818)771-0926  Fax(818)771-0464

CONFIDENTIAL CREDIT APPLICATION

DATE_____________

FIRM NAME_________________________________DBA_____________________________

ADDRESS_______________________CITY_________________STATE_____ZIP_______

MAILING ADDRESS IF DIFFERENT FROM ABOVE

______________________________________________________________________________

PHONE_________________FAX__________________RESALE #______________________

YEARS IN BUSINESS_________________YEARS AT PRESENT ADDRESS____________

OWN____RENT____PARTNERSHIP_____CORPORATION_________________________

STATE INCORPORATED______YEAR____FEDERAL ID# OR S.S. #_________________

PRESIDENT OR OWNER_______________________CONTROLLER__________________

ACCTS. PAYABLE CONTACT__________________BUYER_________________________

DO YOU USE PURCHASE ORDERS?_______ BUSINESS TYPE______________________

BANK CHECKING:______________PHONE #____________ADDRESS________________

CITY__________________STATE_______ZIP____________ACCOUNT #______________

TRADE CREDIT REFERENCES:

1.NAME______________________________4. NAME________________________________

ADDRESS_____________________________  ADDRESS_____________________________

PHONE#_____________________________    PHONE #______________________________

2. NAME______________________________ 5.NAME________________________________

ADDRESS_____________________________    ADDRESS____________________________

PHONE #______________________________    PHONE #_____________________________

3. NAME______________________________6. NAME________________________________

ADDRESS____________________________      ADDRESS_____________________________

PHONE #_____________________________     PHONE________________________________

I/we individually and or collectively promise to pay monthly purchases the 10^th of the month. I/we further assume responsibility for all bills contracted in my name or authorized agent of the company to pay all bills. In the event it becomes necessary for H&H to incur collection costs, the undersigned promises to pay all collection costs, court cases and attorneys fees.

FIRM NAME____________________________SIGNATURE______________________________

PRINTED NAME_________________________TITLE__________________________________

H & H Auto Parts Wholesale
12860 Muscatine St., Pacoima, CA 91331
phone: 818.771.0926
fax: 818.771.0464