MAJCO LLC

14401 Princeton Avenue, Moorpark, CA 93021

Phone: (805) 392-8739

Customer Application Form

Please complete and submit the following application form to apply for a new account.

A corporate line of credit is not guaranteed.

BILLING/INVOICING INFORMATION

Accounts Payable

Billing Address

Address

Address 2

City

State

Zip Code

Phone

Credit Limit Requested

Purchase Order Requirements

PO/RO #Driver's NameUnit #VIN

Additional Instructions

REPAIR INFORMATION

Owner

Phone

Purchasing/Fleet Manager

Phone

Company Vehicle Count

Repair Authorization/Approval

All employees authorizedOwner/Fleet Mgr must approve

BUSINESS/TRADE REFERENCES

Reference 1

Company Name

Account Number

Address

Address 2

City

State

Zip Code

Phone

Reference 2

Company Name

Account Number

Address

Address 2

City

State

Zip Code

Phone

ACCOUNT SETTINGS

Customer Number

Price Level

Class ID

Payment Terms

Finance Charges

Statement Cycle

Credit Limit

Tax Exempt 1

Territory ID

Terms and Conditions

All invoices are to be paid 30 days from the date of the invoice. Invoices past due 30 days are subject to monthly finance charges of 1.50% (APR 18.00%). Monthly statements are sent out on/around the 25th of each month.
Special Orders are subject to a 25% Restocking Fee. All returned checks are subject to a $30 NSF Fee.
The undersigned applicant hereby certifies that the provided information is complete and accurate, and further authorizes MAJCO LLC, and its officers, consent to investigate and or/obtain credit information regarding this application.
The undersigned applicant hereby warrants and represents that he/she is authorized to enter into this agreement. Furthermore, applicant accepts the Terms and Conditions of this agreement.

Acknowledgement

I hereby acknowledge that I have read, understand, and agree to the above Terms and Conditions. I certify that all information provided in this application is true, accurate, and complete to the best of my knowledge. I understand that any false or misleading information may result in denial of credit or termination of any credit extended. By checking this box, I authorize this acknowledgement to serve as my electronic signature and consent to be bound by the terms of this agreement. *

COMPANY INFORMATION

Primary Mailing Address *

BILLING/INVOICING INFORMATION

Billing Address

REPAIR INFORMATION

Owner

Purchasing/Fleet Manager

BUSINESS/TRADE REFERENCES

Reference 1

Reference 2

ACCOUNT SETTINGS

Terms and Conditions

Acknowledgement