Carolinas Auto Supply House

APPLICATION FOR CREDIT/CHECK APPROVAL

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Please Print or Type - Company Checks Only *Field Required for application processing

*Firm Name:

*Phone:

*Owner/Responsible Party

Fax:

Carolinas Account No.

State Tax I.D. No.:

(If New Account):

*Mailing Address:

*City, State, Zip

*Shipping Address (If different from above):

City,State, Zip

*Bank Name:

Branch Address

City, State, Zip

*Checking Account Number:

*Bank Phone: (Must Include Area Code)

Name on Checks

****STOP HERE FOR CHECK APPROVAL ONLY****

CREDIT REFERENCES (Must Be Automotive in Nature)

BODYSHOP / COLLISION *Company Name

Account No. (if applicable)

*Complete Mailing Address

*Phone:*

Fax

*Company Name

Account No. (if applicable)

*Complete Mailing Address

* Phone

Fax

*Company Name

Account No. (if applicable)

*Complete Mailing Address

* Phone

Fax

FAX (704)334-4194

Fax to Accounting Dept. - Carolinas Auto Supply House, Inc.

or mail to:2135 Tipton Dr., Charlotte, NC 28206

Allow 4 weeks minimum for approval for references OR 1 day check approval with order

CAROLINAS AUTO SUPPLY HOUSE

M-F 8:00 AM - 5:30 PM Call: 1.800.438.4070

24/7 Fax 1.800.377.7016

Prices in this catalog are subject to change without notice. Please call a sales representative to confirm current pricing.