Astec Parts Credit Application

Business/Financial Information Required To Open An Account With ASTEC Parts
Business Information
Business Name(*)
Please let us know your name.
Business Address(*)
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Business City(*)
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Business State(*)
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Business Zip Code(*)
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Corporate Officer
Controller
Type of Business
Years In Business(*)
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Office Phone(*)
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Fax Number
Business Email(*)
Please let us know your email address.
Reference Information
Reference 1
Reference 1 Name
Reference 1 Address
Reference 1 City
Reference 1 State
Reference 1 Zip Code
Reference 1 Phone
Reference 1 Fax Number
Reference 1 Email
Reference 2
Reference 2 Name
Reference 2 Address
Reference 2 City
Reference 2 State
Reference 2 Zip Code
Reference 2 Phone
Reference 2 Fax Number
Reference 2 Email
Financial Information
Name of Bank
Bank Address
Bank City
Bank State
Bank Zip Code
Bank Account Number
Bank Representative
Representative Phone
Representative Fax
Type Of Account You Wish To Open
Account Type

Do you have a credit limit in mind?
Are you tax exempt?

If yes, attach your tax exempt certificate.

Upload Certificate

(PDF, DOC, TXT, JPG, BMP)

(*)
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I certify that all of the above listed information is true and complete and is given to Astec, Inc. for the sole purpose of obtaining my companies’ credit history. I also understand and agree to the terms on which Astec, Inc. grants credit. I understand that I will be informed of our credit limit and terms, after an evaluation of our credit history by the Director of Parts, or, in his/her absence, the Manager of Parts. If at any time, we need changes made to either the credit limit and/or terms of payment, it will have to be discussed with the Director of Parts and will be done at his/her discretion.

Signature(*)
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Anti-Spam(*)
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