New Customer - Aviation Airmotive

Business Information

Business Name*

Business Phone*

Business Fax

Company DBA

Tax I.D. Number/VAT No.

Company Address (Street)*

Company Address (City)*

Company Address (State/Province)*

Company Address (ZIP/Postal Code)*

Company Address (Country)*

Type of Business:

In Business Since:

Legal Form Under Which Business Operates:

If Division/Subsidiary, Name of Parent Company:

Subsidiary In Business Since

Business Contact Information

Company Principal Responsible for Business Transactions*

Name of Company Principal Responsible for Business Transactions*

Title*

Company Principal Contact Phone*

Company Principal Contact Email Address*

Company Principal Address (Street)

Company Principal Address (City)

Company Principal Address (State)

Company Principal Address (ZIP/Postal Code)

Country:

Company Principal Address* (Country):

Company Secondary Responsible for Business Transactions*

Full Name

Title*

Company Secondary Responsible Contact Phone*

Company Secondary Responsible Email Address*

Company Secondary Responsible Address (Street)

Company Secondary Responsible Address (City)

Company Secondary Responsible Address (State)

Company Secondary Responsible Address (ZIP/Postal Code)

Secondary Responsible Country Code:

Other Company Contacts:

Sales Manager Contact

Accounting/Finance Contact

Other Contact

Bank Reference #1

Institution Name

Account #

Account Type

Savings Checking

Address

Phone Number

Bank Reference #2

Institution Name

Account #

Account Type

Savings Checking

Address

Phone Number

Credit and Trade Information

Line of credit Requested

Member of IATA: (enter member ###)

Projected Monthly Purchases

Trade References

Trade Reference #1

Company Name

Contact Name

Address

Phone

Account Opened Since

Credit Limit

Current Balance

Trade Reference #2

Company Name

Contact Name

Address

Phone

Account Opened Since

Credit Limit

Current Balance

Trade Reference #3

Company Name

Contact Name

Address

Phone

Account Opened Since

Credit Limit

Current Balance

Trade Reference #4

Company Name

Contact Name

Address

Phone

Account Opened Since

Credit Limit

Current Balance

Trade Reference #5

Company Name

Contact Name

Address

Phone

Account Opened Since

Credit Limit

Current Balance

Trade Reference #6

Company Name

Contact Name

Address

Phone

Account Opened Since

Credit Limit

Current Balance

Review and Signature

I,

Authorized Personnel Name

on behalf of Company,

Company Name

hereby confirm

hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein.

Signature*

Name and Title

Signer's Email

Signature Date (MM/DD/YYYY)