Credit Application

Name: Valley Auto Parts
Address: Hayward 452 W, Tennyson Rd, 94544, US
Telephone: 510-782-5548
Price range: N/A

Valley Automotive Parts
452W. Tennyson Rd
Hayward CA 94544
510-782-5548 Phone
510-783-4678 Fax

Valley Automotive Distributors
205A Shaw Rd
South SF 94080
650-583-9525 Phone
650-583-155 Fax

GENERAL INFORMATION
Business Name
Date
Date Format: MM slash DD slash YYYY
Business Owner's Name
Phone No.*
Fax No.
Address
City
State
Zip
Date Established
Date Format: MM slash DD slash YYYY
Description of Business
Resale No.
Federal Tax Identification No.
P.O. # Required?
Estimated Monthly Volume $
OWNERSHIP INFORMATION
- Corporation
- Partnership
- Proprietorship
- Other
Name of owners, principals or officers of responsible party.
Name
Title
Residence Address
City, State, Zip
Phone No.*
Social Security No.
Name
Title
Residence Address
City, State, Zip
Phone No.
Social Security No.
BANK REFERENCE
Name*
Checking Account No*
Savings Account No
Address
City, State, Zip
Phone No.*
Contact Person*
CREDIT REFERENCES: Give only names with whom you have established credit.
Name
Address
City, State, Zip
Phone No.
Name
Address
City, State, Zip
Phone No.
Name
Address
City, State, Zip
Phone No.
Name
Address
City, State, Zip
Phone No.
I hereby certify that the above information is true and correct to the best of my knowledge. I personally guaranty payment of all charges according to the terms and conditions as stated by Valley Automotive Dist. If I fail to do so, then I agree to pay any late charges, collection expenses, attorney fees or service charges if collection procedures are instituted. I also certify that Valley Automotive Dist. is authorized to investigate and report to proper persons and bureaus my performance of this account.
Signed*
Title
Date
Date Format: MM slash DD slash YYYY
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Comments
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GENERAL INFORMATION

OWNERSHIP INFORMATION

BANK REFERENCE