CREDIT LINE APPLICATION
PERSONAL CONTACT
Title Date Business Commenced
Company Principal |Owner Spouse | Partner
Phone | Fax Mobile
Personal E-mail Business E-mail
Home address Website
City, Province, ZIP Code
Facebook Page
BUSINESS REGISTRATION INFORMATION
Line of Business Trade Name
Sole proprietorship Corporation
TIN Partnership Other
Registered Business Address Years at Current Address? Please mark appropriate box:
City, State ZIP Code
Owned
*** Please provide a sketch of your
business address (landmarks included)
with Google Map image attached. You
Rented
may use the back page or separate
paper.
No of Years in the Business
Hauler For: Own Company Other Company, pls. specify Both
name ____________________
Contractor For: Government Private Both
Trade References: (you may 1. 2. 3.
provide up to 3 company names)
Size of Fleet in number of units: Tires to be used for? Own trucks Re-selling
Are your Trucks: Owned Financed Rented
Current Supplier/s Please mark applicable box if Business Permit from Mayor’s
1. document has been attached: office
DTI
2. SEC (Partnership or
Incorporation)
BIR Certificate of Registration
3.
Photocopy of any valid Gov’t
issued ID of owner
Photocopy of any valid Gov’t
issued ID of authorized
representative
FINANCIAL INFORMATION
Bank Name (specify Branch) Account Number Contact Person & number Years in Business with the Bank
1.
2.
3.
PREFERENCES
Preferred Mode of Payment COD PDC Others: __________________
Frequency of Statement: Monthly Per transaction 2 weeks before account is due
Statement of Account (SOA) Would you require a P.O. YES
should be made out to:
(Purchase Order) before NO NEED, signed D.R. is
releasing payment? sufficient
Person-in-Charge/Contact details Position in the company
(who’s authorized to order in the Mobile number
absence of the owner):
Email address
Person-in-Charge/Contact details Position in the company
(who can receive Statement of
Mobile number
Accounts in the absence of the
owner): Email address
AUTHORIZATION
I hereby certify that the above information is true and correct. I have given it freely and voluntarily with the understanding that it is
to be used to determine the amount & conditions of the credit to be extended.
Furthermore, I hereby authorize the financial institutions listed in the credit application to release necessary information to the
company to which credit is being applied in order to verify the info contained herein.
SIGNATURE OVER PRINTED NAME DATE:
_____________________________________ ____________________________________
SIGNATURE SPECIMENS
Signature Signature
Name and Title Name and Title
Date Date
MMV-2020
AGENT SUMMARY REPORT
Has the customer provided a detailed
sketch of their business address YES NO
(landmarks included) with Google
Tire Sizes/PSI Map image attached?
With commission? YES NO Please select one: Radial BIAS
Motorpool Person in-charge
Address
Truck Route Truck Fleet Summary
(Please provide specific details on
your summary)
Remarks:
__________________________________________________________________________________________________________
___________________________________________________________________________________________________________
__________________________________________________________________________________________________________
Agent Name: ____________________________
Date of Client Review: _____________________
Application Status: ________________________
Verified by: ______________________________
Note: All information contained herein will be handled with strictest confidence and is for the purpose of our records only.
