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Components for the Transportation Industry
 
Please fill out form online and click submit at the end of the application, or print
application and fax to 937-859-3303
 
  Attention: Credit Dept. Of*:  
  The applicant below has requested credit from us and given your name as a reference. We
would appreciate your cooperation in helping us make a fair determination. We will maintain
this information in the strictest confidence.

Thank You,


Jeff Underwood - APT Corp
 

     Reference Form (Fields marked * are required)
  Re*:  
       
  Date Account Opened:  
       
  Date of Last Sale:  
       
  Terms of Sales:  
       
  High Credit in Last 12 Months:  
       
  Amount Now Owing:  
       
  Amount Past Due:  
       
  Days Past Due:  
       
  Discounts:  
       
  Prompt:  
       
  Slow:  
       
  COD:  
       
  1-30 Days:  
       
  Over 60:  
       
  Any NSF Checks:  
       
  Comments: