Business Name:

Business Address:

Reply Email Address:

Telephone No.:

Amount of Credit Requested:

Type Of Business:

Owner or Principal:

Address:

Company Officers:

Bank Reference: (Name, Address, Phone, Account Number, Account Rep...)

Trade References: (Name, Address, Phone, Contact)
1)
2)
3)
4)

Tax Exempt: Yes No

If exempt, a completed exemption certificate must be mailed with a print-out of this application to:
Coletta's Auto Service 425 Richmond Street, Providence, RI 02906

I certify that all statements accompanying and contained in this application are true and are made for the purposes of obtaining credit and in consideration of Coletta's and/or subsidiaries selling to me or to my agent(s). I agree to the following terms:
1. To pay the account in full within the terms given to my account.
2. To pay a service charge for late payment, computed as an annual percentage rate of 18% (periodic monthly rate of 1 1/2%) or such other rate as then may be in effect on all balances remaining unpaid 30 DAYS after date of purchase.
3. If this account is placed for collection, I agree to pay all reasonable charges for collection including attorney's fees.
4. The undersigning individual personally guarantees payment of all bills of the applicant.

I ACCEPT

Name of authorized officer or principal: