Police Car lights, Emergency Vehicle lights, Emergency Vehicle Equipment

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Credit Application

Payment Methods

Note: If you are a government owned entity, simply fax a copy of your letterhead to (901) 377-5633 and you are approved. This form is for non-government owned businesses seeking credit approval.

Credit Application
Company Name:
Address:
City, State, Zip:
Email:
Phone No:				Fax No:
Kind of Business:
Select One:	Individual: Partnership: Corporation:


References: Bank -	Name:
	Address:


Credit References:	1.	Name:
		Customer No:
		Address:
		Phone:		Fax No:
	2.	Name:
		Customer No:
		Address:
		Phone:		Fax No:
	3.	Name:
		Customer No:
		Address:
		Phone:		Fax No:
	4.	Name:
		Customer No:
		Address:
		Phone:		Fax No:
	5.	Name:
		Customer No:
		Address:
		Phone:		Fax No:
	6.	Name:
		Customer No:
		Address:
		Phone:		Fax No:


Sales Tax Status:	Taxable:
	Resale:		(Certificate Will Be Requested)
	Exempt:		(Certificate Will Be Requested)


I understand that Fleet Safety Equipment Inc's payment terms are "NET 30" and agree to pay according to those terms

Accounts Payable Contact:		Name:
		Phone:		Fax:


Statements Sent By Request.
I do require a monthly statement:
I do not require a monthly statement: