Please print and fill out this application and then mail to Accounts Receivable at the Londonderry
address which is listed at the bottom of every page. Or you can also fax it to us at (603) 432-4701.

CREDIT APPLICATION

Thank you for selecting Freightliner of NH, Inc. as your truck parts and service supplier.
To expedite the processing of your account application, please answer all questions completely.

Name of business or individual applying for credit: _________________________ Date: __________

Address: ________________________ City: _____________________State:_____ Zip:_________

Telephone: (___) __________________ FAX: (___) ______________

Cellular: (___) ______________ Pager:(___) ___________

Email: __________________________ Accts. Payable Contact: ____________________________

Organization: o Corporation o Individual o Partnership o Other ______________________

If corporation, list officers:
President _______________________________ Vice President____________________________

Treasurer _______________________________ Secretary/Clerk ___________________________

Company History: Date Business Started ___________ Date Business Incorporated ______________

State of Incorporation __________________________ Type of Business ______________________

Credit Limit Desired ___________________________ Are PO’s required?   o Yes   o No

Bank reference:

Bank name: __________________________________ Contact: ____________________________

Address: ________________________ City: __________________ State: ______ Zip: __________

Telephone: (___) __________________ Checking Account # _____________________

List 3 active credit references:

1) Name: _________________________________________

Address: ________________________ City: __________________ State: ______ Zip: __________

Telephone: (___) __________________ Contact: ___________________________

2) Name: _________________________________________

Address: ________________________ City: __________________ State: ______ Zip: __________

Telephone: (___) __________________ Contact: ___________________________

3) Name: _________________________________________

Address: ________________________ City: __________________ State: ______ Zip: __________

Telephone: (___) __________________ Contact: ___________________________

CREDIT AGREEMENT:

Applicant hereinafter referred to as Debtor, certifies under penalties of perjury that the information contained in this application is accurate and true, and hereby authorizes Freightliner of NH, Inc. to obtain credit information and references. In the event Freightliner of NH, Inc. permits the Debtor to make purchases of goods and services on account, Debtor agrees to the following:

I. TERMS OF PAYMENT

The Debtor agrees to pay Freightliner of NH, Inc. the entire outstanding balance on its account within 30 days of receipt of monthly statement. The Debtor agrees that a FINANCE CHARGE of 1 ½ percent per month or Eighteen (18) percent per annum will be assessed on a past due balances commencing on the thirty-first day from the statement.

II. COST OF COLLECTION

In the event that Freightliner of NH, Inc. must pursue legal action to collect any sums the Debtor owes under the terms of this credit agreement, then the Debtor specifically agrees to pay ALL costs of collection including reasonable attorney’s fees. The outstanding balance will continue to accrue interest at the rate of 1 ½ %m per month or 18% per annum from the date of assignment for collection.

III. SUSPENSION OF CREDIT

Freightliner of NH, Inc. reserves the right, at any time, with or without notice, to suspend credit or to change credit terms stated herein.

IV. NOTICE TO DEBTOR

1. Do not sign this agreement unless you have read it, or if it contains blank spaces.
2. The Debtor may pay the total debt at any time without pre-payment penalty provided all of the terms and conditions are met.
3. Debtor is entitled to a complete copy of this agreement
   

This is a agreement, DO NOT SIGN DOCUMENT UNLESS YOU HAVE READ AND UNDERSTOOD ALL OBLIGATIONS OF THE DEBTOR. This agreement constitutes the entire contract between Debtor and Freightliner of NH, Inc. No other representations should be implied from the written or oral negotiations that preceded this agreement.

Signature / Title ___________________________________ Social Security Number / Tax ID #______________________________

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Freightliner of New Hampshire
Route 102, P.O. Box 1440, Londonderry, NH 03053
Main number: 603.421.9000 or 800.533.3637
Parts hotline: 603.421.9009 or 800.360.5360

165 Heater Road, Lebanon, NH 03766
Main number: 603.443.9955 or 888.443.9955

webmaster@fnh.com © Copyright 1997 Freightliner of New Hampshire/JFC