Wheels, Inc. Credit Application Complete Form and Fax to (540) 366-3442 Credit Contact Information First Name: Last Name: Phone: Fax: E-mail: Address:     City: State: ZIP: SSN: Sole proprietorship: Partnership: Corporation: Other: Business and Credit Information Primary business address: City: State: ZIP: How long at current address? Telephone: Fax: E-mail: Bank name: Bank address: City: State: ZIP: Phone: Type of account Account number Savings   Checking   Other   Business and/or trade references Company name: Address: City: State: ZIP: Phone: Fax: E-mail: Type of account: Company name: Address: City: State: ZIP: Phone: Fax: E-mail: Type of account: Company name: Address: City: State: ZIP: Phone: Fax: E-mail: Type of account: Agreement By submitting this application you authorize Wheels, Inc. to make enquiries to the Credit accounts, banking, savings, business, and/or trade references you have supplied. Signatures       Title: Date:       Title: Date: