Cook Brothers Truck Parts

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All data collected here is sent over a secure connection and encrypted at rest. Data older than 30 days is automatically deleted. Cook Brothers does not share your information with any outside vendors. For questions and concerns please contact our corporate headquarters at 1-800-836-2665.

Business Information

Applicant Email

Store/Facility Location

Account Line Requested

Federal Tax Number

Firm Name

Trade Style or Divisions & Locations

Street Address

Phone

        
        City
    
        State
    
        Zip

Previous Address (if present one is less than 5 years)

        
        Please select: 
    
            Check this box if a financial statement has been given
        
            Tax exempt? If yes attach form.
        
            Voucher Required

Owner Information

                
                Full Name of Owner
            
                Date of Birth
            
                Social Security Number

                
                Street Address
            
                City
            
                State
            
                Zip

Add Owner

Finance charge of 18% per annum on all past due accounts

The above information is for the purpose of obtaining an open account and is warranted to be true. I/We hereby authorize Triple Cities Acquisition, LLC to investiage the references listed pertaining to My/Our credit and financial responsibility and to obtain a credit report regarding my credit worthiness, credit rating and credit capacity.

If I fail to keep my agreement (called a "Default") and you need to sue me or take any other action to collect what I owe you, I will pay your collection costs and reasonable attorney's fees.

BY SIGNING THIS FORM, APPLICANT(S) AGREE TO THE ABOVE TERMS AND CONDITIONS AND ATTEST FINANCIAL RESPONSIBILITY, ABILITY, AND WILLINGNESS TO PAY OUR INVOICES IN ACCORDANCE WITH THE FOLLOWING TERMS: NET 30

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Cook Brothers Credit Application

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Select Default Branch