Type of Business ... The undersigned understands that the terms on invoice
rendered by 5-Minute Oil Change / Take 5 Oil Change for services received are ...
CONFIDENTIAL BUSINESS CREDIT APPLICATION Corporate Office • 2450 Severn Avenue, Suite 308 • Metairie, LA 70001 (504) 837-0670 ext. 103 • Fax (504) 828-2238
Company Name____________________________________________________________________________________ Street Address_____________________________________________________________________________________ City _________________________________________________ State ________ Zip____________________________ Billing Address____________________________________________________________________________________ City _________________________________________________ State ________ Zip____________________________ Phone Number ____________________________________ Fax Number______________________________________ Type of Business___________________________________________________________________________________ q Sole Proprietorship
q Partnership
q Corporation
Number of Years in Business _______________________________ Number of Vehicles__________________________ Name of Principal ______________________________________ Title________________________________________ TRADE REFERENCES
Name
Phone
Fax
City/State/Zip
1._______________________________________________________________________________________________ 2._______________________________________________________________________________________________ 3._______________________________________________________________________________________________ 4._______________________________________________________________________________________________ Bank Name_______________________________________________________________________________________ Address__________________________________________________________________________________________ Information Required on Your Receipts (please circle requested)
P.O. Number
License Plate Number
V.I.N.
Unit Number
Please mail all checks to our corporate office – 2450 Severn Avenue, Suite 308 • Metairie, LA The undersigned understands that the terms on invoice rendered by 5-Minute Oil Change / Take 5 Oil Change for services received are payable net 30 days from the date of the invoice. Accounts begin to accrue an interest charge at the rate of on and on-half percent (1.5%) per month after 30 days. It is agreed that in the event that an account is turned over to an attorney for collection, you will pay the total legal cost.
Signed ___________________________________ Principal
Personal Guarantee by ____________________________________ Principal / Date
