Truck Financing - Five Star Isuzu

Business Information

Business Name (Legal Name)(Required)

Accounts Payable Contact(Required)

Doing Business As (DBA)(Required)

Phone(Required)

Physical Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Email(Required)

Fax #(Required)

Billing Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Email Monthly Statements To:(Required)

Email Invoices To:(Required)

Ship To Address (If Different)(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Shop Contact(Required)

Phone(Required)

Email(Required)

Purchase Order Required? (Y/N)(Required)

Tax Exempt (Y/N)(Required)

If Yes, you must provide a valid Exemption Certificate

Business Type:

Sole Proprietorship(Required)

Partnership(Required)

LLC(Required)

Corporation (State)(Required)

Government(Required)

Fed ID#(Required)

US DOT#(Required)

Duns #(Required)

Date Business Started:(Required)

Number of Employees:(Required)

Fleet Size:(Required)

Describe Your Business:(Required)

Business or Any Principal Ever Declared Bankruptcy? (Y/N)(Required)

List when and where filed(Required)

Any Outstanding Liens or Judgments? (Y/N)(Required)

List details and disposition(Required)

Owners or Principals

Name(Required)

Title(Required)

Social Security #(Required)

Home Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone(Required)

D/O/B(Required)

How Long At This Address?

Year(Required)

Months(Required)

Has this individual ever filed personal bankruptcy or had a company in which he or she was a principal filed bankruptcy? (Y/N)(Required)

Name(Required)

Title(Required)

Social Security #(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Phone(Required)

D/O/B(Required)

How Long At This Address?

Year(Required)

Months(Required)

Has this individual ever filed personal bankruptcy or had a company in which he or she was a principal filed bankruptcy? (Y/N)(Required)

Banking Information

Name Of Bank(Required)

Account Types(Required)

Address(Required)

Contact(Required)

Title(Required)

Phone(Required)

Business Loans or Personal Loans for Business

Lender Name(Required)

Account #(Required)

Amount Owed(Required)

Address(Required)

You Regularly Purchase From (Please Include Email and Fax)

Company Name(Required)

Email(Required)

Fax(Required)

Phone(Required)

Company Name(Required)

Email(Required)

Fax(Required)

Phone(Required)

Company Name(Required)

Email(Required)

Fax(Required)

Phone(Required)

ACCOUNT AGREEMENT

Terms and Conditions

Parts and Service Terms are Net 10th. All purchases made in one calendar month are due on the 10th of the following month.
Please mail payments to FS Isuzu, P.O. Box 64006, Baltimore, MD, 21264-4006
Payments are also accepted by ACH, Credit Card or at one of our locations.
We will add a $50.00 fee to your balance for each check that is not honored or returned to us.
Any account that is deemed past due is subject to a 1 1/2% late charge ($1.00 minimum) per month.
Late charges are calculated on the entire past due balance, which may contain prior late charges.
Any court costs, attorney fees or charges associated with collecting on a delinquent account are the responsibility of the applicant.
Applicant agrees to allow FS Isuzu, LLC to select the legal venue should litigation occur.
You hereby agree to full and prompt payment of all indebtedness and obligations as expressed in this agreement, including late charges and collection fees paid or incurred by FS Isuzu, LLC in the endeavoring to collect such indebtedness, even if such indebtedness is in excess of the applied for or established credit line.
Your status may be placed on hold if your balance becomes past due or over your credit limit; keep track of your charges and balance.
If ownership of more than 25% changes, FS Isuzu, LLC must be notified in writing, certified mail, return receipt requested at 1810 S.19th Street, Harrisburg, PA 17105 It is your responsibility to keep our files updated with your most current billing address and telephone number.
If your payment does not specify which invoices to pay, we will apply it to the oldest items first, even if those items are late charges.
If credit is granted, we may suspend or terminate credit privileges at any time, for any reason, or for no reason at all, without incurring any liability to FS Isuzu, LLC.
Applicant herteo knowingly and intentionally waives the right to a jury trial on any issue or dispute that may arise.
Applicant agrees that each and every term and condition of this Agreement shall be a term and condition of every future sale to Applicant, regardless of whether these terms or conditions are stated on any particular invoice.
We can delay in enforcing or fail to enforce any of our rights under this agreement without losing them.
The undersigned warrants that the above agreement has been carefully read and understood; in the case of a Corporation or Partnership, the undersigned represents that he or she has the authority to enter into this credit agreement on behalf of said Corporation or Partnership.
By signing below and utilizing your credit account, you acknowledge and accept these terms as part of your credit agreement.

Owner Signature:(Required)

Title(Required)

Print Name:(Required)

Date(Required)

Authorized Agent Signature:(Required)

Title(Required)

Print Name:(Required)

Date(Required)

Consumer Credit Report Authorization

The undersigned hereby consent(s) to FS Isuzu, LLC use of a non-business consumer credit report on the undersigned in order to further evaluate the credit worthiness of the undersigned as principal(s), and/or guarantor(s) in connection with the extension of business credit as contemplated by this credit application. The undersigned hereby authorize(s) FS Isuzu, LLC to use a consumer credit report on the undersigned from time to time for the extension or continuation of the business credit represented by the credit application. The undersigned as an individual(s) hereby knowingly consent to the use of such credit report consistent with the Federal Fair Credit Reporting Act as continued in 15 U.S.C @ 1681 et seq..

Print Name(Required)

Signature(Required)

Print Name(Required)

Signature(Required)

Personal Guaranty of Payment

In consideration of the extension of credit to the above Applicant, the Guarantor(s) hereby warrants and unconditionally guarantees to FS Isuzu, LLC the full and prompt payment when due of all indebtedness, obligations, and liabilities of customer to FS Isuzu, LLC as express, including late charges if applicable thereto, now existing or hereafter created or arising, even if such indebtedness is in excess of the applied for or established credit line, and including legal fees and costs paid or incurred by FS Isuzu, LLC in endeavoring to collect such indebtedness or part thereof or in enforcing this guaranty. The incorporation, merger, reorganization or sale of the customer's business shall not operate as a termination of this guaranty.

Print Name(Required)

Signature(Required)

Print Name(Required)

Signature(Required)