Customer Account Application
Select a business type
Automotive Repair Shop
Body Shop/Collision
Car Dealer
Custom/Specialty Shop *
Fleet *
Glass Repair
Jobber/Parts Retailer
Machine Shop
Quick Lube
Transmission Shop
Other________________ *
* Fill out Fleet/Other Section
General Information
How many technicians? How many service bays?
How many vehicle lifts? Estimated monthly
purchases?
*Fleet/Other business type information
What is your primary business?
How many service vehicles do you maintain?
National Account Affiliation
ATD Service Bay (IPG)
BARNN Bridgestone Net.
Big O Tires
Bosch Car Service
Goodyear
Grease Monkey
IPG Installed Parts Group
ITDG Independent Tire
Les Schwab
Lithia
Meineke
Midas
Monro
Point S
TBC Retail Group
Tire Pros (IPG)
Other____________________(Please tell us, our buying group has many programs)
SMS Shop Management Information
Aconnex
Bay-Master
Mitchell
Partstech
Pace Software
R.O. Writer
ShopKey
Shop Monkey
TireShop
Turbo Shop DST
Winworks
Other________________
Customer Account Application
Customer Information
Company Name
DBA
Fed ID #
# Employees
Sole Proprietor
Corporation
Partnership
Other
Billing Address
How Long at Current Address (Years)
City
State
Zip
Business Phone #
Business Fax #
Mobile #
Business Email
AP Contact Name
AP Email
AP Phone Number
Delivery Address (if Different from Above)
City
State
Zip
Owner/Applicant Name
Owner/Applicant Social Security #
Title
Owner Home Address
Owner Mobile #
DOB
City
State
Zip
Email Address
Co-Owner/Applicant Name
Co-Owner/Applicant Social Security #
Title
Home Address
Mobile #
DOB
City
State
Zip
Email Address
Type of account (requested)
Cash
Weekly Pay
Monthly Pay (Due on the 5
th
)
Projected monthly Volume $
Bank Name
Bank Phone Number
Bank Account #
Bank Address
Bank City, State, Zip
Credit Reference # 1
Credit Reference Phone Number
Credit Reference Account #
Credit Reference # 2
Credit Reference Phone Number
Credit Reference Account #
Credit Reference # 3
Credit Reference Phone Number
Credit Reference Account #
Customer Account Application
As an owner or principal officer of the business application (the “Company) and/or as an officer authorized to sign
credit instruments for the Company name in this application, I authorize Trimon Inc. DBA Monument Car Parts,
Superior Auto Warehouse to obtain any information it may request from any business or consumer reporting
agency(ies) or other sources that provide credit reports, account history reports, credit and employment history, or
similar information, under the names and social security numbers of any and all owners and/or officers I provide.
The undersigned applicant certifies that the information given is correct and complete, and further agrees to permit
Trimon Inc. to use this information to obtain additional required credit information. If, after reviewing all credit
information, this applicant is approved, it is agreed and understood by the undersigned and Trimon Inc. that all
purchases made on an account will be PAID IN FULL on or before the 10
th
day of the month following the date of
the purchase. No unpaid account will be increased after the 20th day, unless by special agreement. Further, any
account that has an unpaid balance at the end of the month in which payment was due will be assessed a finance
charge on the unpaid portion at the highest rate allowable by applicable laws until such time as the account has
been brought current. In the event Trimon Inc. employs an attorney or collection agency to collect any amount due
from applicant, applicant shall be responsible for all cost of collections including (without limitation) attorney’s fees,
court costs, and any contingency fees paid to a collection agent.
Authorized Signature_______________________________ Social Security__________________ Date_________
Name__________________________ Company_________________ Title_______________________________
INDIVIDUAL PERSONAL GUARANTEE
I, ______________________________ (print name), residing at _______________________________________
_____________________________ (print address) for and in consideration of your extending credit at my request
to _______________________ (the Company) of which I am (Title)__________________________, and as
material inducement therefore, hereby absolutely and unconditionally guarantee to Trimon Inc. DBA Monument
Car Parts, Superior Auto Parts Warehouse the due and punctual payment on demand of all debts and liabilities
owed to Trimon Inc. by the Company. This guaranty shall remain an unconditional and continuing guaranty of
payment, and not of collection. I acknowledge that my liability is primary rather than secondary. I do hereby waive
of presentment, demand, protest, dishonor, default and/or nonpayment of such debts and notice of any modification
or further extension of credit to the Company, to which I hereby contest. I further agree that no failure or delay on
the part of Trimon Inc. in exercising of its rights hereunder shall operate as a waiver thereof, nor shall any single or
partial exercise of any such right preclude any other or further exercise of any rights that Trimon Inc. may give
under this guaranty, and that my obligations hereunder shall not be subject to any rights of setoff, recoupment,
deduction or counterclaim. In the event my obligations herein are collected by or through a third party, then Trimon
Inc. shall be entitled to recover all costs of collection including attorney’s fees.
Authorized Signature_______________________________ Social Security__________________ Date_________
For Office Use Only
Account # _____________ Myplace4Parts Login______________ Blue Jay_______________
Salesman #____________ Equifax Score_________________ Credit Limit_______________
Authorized by__________________ Signature of Authorizing Person_____________________
Customer Contacted on_______________ Customer Contacted by______________________
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Customer Account Application
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