Truck Equip Inc

Name of Firm or Individual^*

Address^*

City^*

State^*

Zip Code^*

County^*

Email^*

FAX

Social Security No. or Federal I.D No.^*

Years in Business^*

Years at this address^*

Phone #^*

Tax Exempt

Yes No

Do you want access to eStore?

Yes No

HEREBY applies for credit in accordance with the terms and conditions of Truck Equipment, Inc.

The following information must be provided. It will be held in the strictest of confidence^*

Corporation
Check here if incorporated within the past 12 months
Partnership
Individual

Ownership

Name of Principal^*

Address^*

City^*

State^*

Zip Code^*

FAX

Name of Principal

Address

City

State

Zip Code

FAX

Banking Information

Bank Name^*

Bank Address^*

Bank Officer or Department

Email^*

FAX

Trade/Credit References

Reference #1

Company Name^*

Complete Address^*

ZIP^*

Contact Person^*

Phone

Email^*

FAX

Reference #2

Company Name^*

Complete Address^*

ZIP^*

Contact Person^*

Phone

Email^*

FAX

Reference #3

Company Name^*

Complete Address^*

ZIP^*

Contact Person^*

Phone

Email^*

FAX

Reference #4

Company Name

Complete Address

ZIP

Contact Person

Phone

FAX

Check here if cash sales are today until credit is approved.

We certify that all the information on this form is correct. We fully understand your credit terms and agree to the proper payment in consideration of extended credit. I hereby authorize the above references and bank to release credit information to Truck Equipment Inc.

Signature^*

Date^*

Title^*

Complete if Tax Exempt

Wisconsin Department of Revenue

Income, Sales, Inheritance & Excise Tax Division

Post Office Box 8903

Madison, Wisconsin 53708

Certificate of Exemption

Single Purchase Continuous

The undersigned hereby claims exemption on the purchase, lease or rental of tangible personal property or taxable service form. (Name of Seller or Lessor)

Based upon his or her proposed exempt use of the item purchased or the exempt status of the purchasing institution as shown below.

1. Containers and other packaging, packing and shipping materials used to transfer merchandise to customers of the purchaser.

2. Tangible personal property becoming an ingredient or component part of an article of tangible personal property in any form destined for sale.

3. Trailers, or accessories, attachments, parts, supplies, materials and service on motor trucks, tractors and trailers which are used exclusively in common or contract carriage under Authority No.

4. Items or services purchased directly and used by a religious, charitable, educational, scientific or other organization holding a Certificate of Exempt Status. CES No.

5. Railway cars, locomotives and other rolling stock used in railroad operations, or accessories, attachments, parts, lubricants or fuel therefor.

6. Commercial vessels (and barges) of 50‐ton burden or over engaged in interstate or foreign commerce or commercial fishing, and accessories, attachments parts and fuel therefor.

7. Other purchases exempted by law. (State items and exempt use.).

8. Resale Certificate SP No.

If “continuous” exemption is checked above, this certificate shall continue in force until revoked and shall be considered as part of each order given to the above named seller or lessor. Use of this certificate does not exempt sales of taxable items for uses other than certified above. Misuse of this certificate by the seller, lessor, buyer, lessee, or other representative may constitute a misdemeanor.

Purchaser's Business Name

Authorized Signature

Purchaser's Address

Title

Date

Purchaser's or Lessee's Business Activity (e.g. Grocer, Utility, Trucker, etc.)

This form is not to be used by farmers, or manufacturers purchasing machinery and equipment; they should use the exemption forms designed for their use.

Sellers must retain this form as a part of their records.This Form May Be Reproduced

Ownership

Banking Information

Trade/Credit References

Reference #1

Reference #2

Reference #3

Reference #4

Complete if Tax Exempt

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