Charge/Fleet Account Application

COMPANY INFORMATION

Company Name:
Contact person:
Billing Address:
City:
State:
Zip:
Phone:
E-Mail:
Tax Exemption?:
Business Type:

TRADE REFERENCES

TRADE REFERENCE #1

Name:
Account Number:
Address:
City:
State:
Zip:
Phone:
Fax:
TRADE REFERENCE #2

Name:
Account Number:
Address:
City:
State:
Zip:
Phone:
Fax:
TRADE REFERENCE #3

Name:
Account Number:
Address:
City:
State:
Zip:
Phone:
Fax:
BANK REFERENCE

Bank Name:
Address:
City:
State:
Zip:
Phone:
Fax:

VEHICLES COVERED

Year Make Model VIN #

READ THE FOLLOWING STATEMENT CAREFULLY BEFORE SIGNING THIS APPLICATION.

I, the undersigned, am authorized to submit this information on behalf of the above named company to request authorization to become an Expresso Car Wash. Inc. account. I authorize Expresso to contact the above credit references. I understand that this account is conditional upon the above named company maintaining a favorable payment and credit history with Expresso Car Wash, Inc. I understand the terms on the invoice from Expresso will be net 30 days. I further understand that a 1.5% service charge per month will be levied for all invoices which are past the 30 day due date. The vehicles listed above will be the ones using this charge account.
Company Representative:
Title:
Your initials as signature:
Today's Date: