Timco
Thank you
 Print: Mail, Fax or Email Form Please complete this form, print, then
Fax, to 361/668-0036 or Mail to the address at the bottom of the page.
You can Email this form if you like, by pressing "Email" below. Thank you!

Customer Information

This is an application for credit. 
Application for lease of equipment for commercial accounts.
All information is kept confidential unless you tell us otherwise. Your telephone or fax number helps us contact you for technical and billing questions.

Please feel free to write other information you think is necessary

FIRST NAME
MIDDLE
   LAST

STREET ADDRESS

CITY
STATE
ZIP CODE

Home phone (with area code)
Work phone (with area code))

Federal ID or Social Security Num.
Driver's license and issuing State & Expire date if any

Company name


Company address


Company City & State


Company Zip code


Approximate dollar amount requesting
Any additional comments

Your Email Address

E-MAIL ADDRESS (one address only, no Web sites) i.e.,yourname@xyz.com(optional)

Payment Information

All of your payment information is kept strictly confidential.

TimcoUSA

 		   I or We hereby authorize TimcoUSA and any other agency employed by TimcoUSA to investigate my company credit records as well as  my or our personal credit records. I, or we hereby authorized Banks and other institutions to release information pertaining to my credit and financial responsibility. I, or We hereby certified that the forgoing information is furnished to TimcoUSA for the purpose of obtaining credit and is true and correct to the best of my knowledge. 
Bank Name
Acct. Num.
Phone & Contact Person
 
Please write: Years in business
Type of business
Corporation or Individual
Business bldg. own or rent
Please list two or more references: Businesses that have extended credit to you.
Names, phones,contact person. 

YOUR SIGNATURE:
_________________________________      Date __________
 TimcoUSA
Print & Mail or Fax
361/668-0036
427 So. Reynolds St.    Alice, Texas 78332
If you preferred you can Email this form here
this is a secure site. just press: Email.
This web page and web site has been developed and is maintained exclusively by RE Enterprises, DAB Eflash.com an Independent
Timco Representative. As Timco modifies its products, programs, and policies, information contained in this web site is subject to change.
This web site is authored ,sponsored and maintained by Timco. All rights reserve