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Join us for FREE Bendix Brake Training!!!September 27th in Bangor andSeptember 28th in South Portland - Call either of our Parts Departments for more info.

South Portland:

42 Wallace Ave. South Portland, Maine 04106

• GPS:N43° 36.8718\',W070° 18.3936\'

• Phone:

207-775-6328

800-540-7098

• Fax: 207-775-0336

Bangor:

2239 Odlin Road Hermon, Maine 04401

• GPS:N44° 46.8309\', W068° 50.5933\'

• Phone:

207-942-6753

800-244-7382

• Fax: 207-942-0007

THERMO KING OF PORTLAND

Individual Credit Application

INDIVIDUAL CREDIT APPLICATION

(PLEASE ANSWER ALL QUESTIONS. IF NOT APPLICABLE, WRITE N/A.)

Name	Phone
Street / Billing	Mailing Address
City	State
Zip	E-Mail address
Type of Business	Years in Business
No of Heavy Duty Trucks	Referred by
Operator License No.	State of :
Social Security No.	Date of Birth
Name of Spouse	Residence:	Own Rent
Name of Mortgage Holder / Landlord	Address
Monthly Amount	Gross Monthly Income
Net Income	Other Income
Bank	Account No.

EMPLOYMENT FOR PAST 5 YEARS
INCLUDE COMPANY NAME, ADDRESS, HOW LONG YOU WORKED THERE AND YOUR POSITION

BUSINESS REFERENCES

INCLUDE NAMES, ADDRESSES AND PHONE NO, MUST BE AT LEAST 3 PARTS, SERVICE OF FUEL ACCOUNTS

NOTE: IF OPEN ACCOUNT IS AUTHORIZED, IT IS UNDERSTOOD THAT ALL PURCHAES BE DUE AND PAYABLE BY THE TENTH OF THE MONTH FOLLOWING DATE OF PURCHASE. A 1 ½% PER MONTH LATE CHARGE WILL BE ADDED TO ALL BALANCES OVER 30 DAYS OLD. THE UNDERSIGNED WILL ALSO BE RESPONSIBLE FOR ALL COSTS OF COLLECTION, INCLUDING REASONABLE ATTORNEY’S FEES, INCURRED IN COLLECTION OF THIS ACCOUNT.

Signed by: Date:

We will make every attempt to process this application as quickly as possible. Please understand a minimum of two weeks is required.