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CREDIT APPLICATION

Personal Information:

Business Status:	Individual Partnership Proprietorship Corporation ( “C” Corp “S” Corp)
In Business Since:
How Many units do you currently have on the road?
Tax ID Number:
Full Name:
Business Phone:	Home Phone:
Fax:
Alternate Contacts:	Cell Phone: Pager:
E-mail:
Street Address:
City:	State: Zip:
Country:


	Corporate Information:

If Applicant is a Corporation complete this section:
President:		% of Ownership:
Vice President:		% of Ownership:
Secretary:		% of Ownership:

Listing of References: (Please list repair shops, not fuel and tire stops)

Bank Name:
City, State:	Phone Number:
Reference #1:
City, State:	Phone Number:
Reference #2:
City, State:	Phone Number:
Reference #3:
City, State:	Phone Number:


Additional Comments or Questions:


	By clicking the “I Agree” button below, you are agreeing that the information given on this application is true and complete. Custom Diesel Services, Inc. (CDS) may receive from other persons, including credit-reporting agencies, information about Applicant’s accounts and credit experience and Applicant authorizes any person to release to CDS credit experience and account information on the Applicant. This shall be a continuing authorization for all present and future disclosures of account information and credit experience on Applicant made by CDS, or any person requested to release such information to CDS.



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ASK ABOUT THE GREAT RATES AT OUR PARKING/STORAGE FACILITY FOR RV’s, TRUCKS, TRAILERS, BOATS and More!

Custom Diesel Service, Inc.
1513-25 E. Jonathon Street, Allentown, PA. 18109
Phone: 610-437-2626 Toll Free: 1-800-800-4CDS
Fax: 610-437-0309

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