Credit Account Application — Brake & Truck Supply

Business & Contacts

Principals, Refs & Banking

Docs & E-Signature

1Business Information

Legal Business Name *

Legal business name is required.

DBA (Doing Business As)

Federal EIN *

EIN is required.

Years in Business *

Years in business is required.

Business Phone *

Phone is required.

Billing Address *

Billing address is required.

Business Website

Is your shipping address different from billing? *

No — same as billing Yes — I'll enter a separate address

1Contact Information

List the people who place orders and handle invoices. At least one contact of each type is required.

Parts Purchaser / Mechanic

Person in Charge of Paying the Bill / AP

2Principals & Ownership

List all owners or officers with 10%+ ownership. At least one is required.

3Trade References

We use your trade references to establish your credit limit. Three references required.

Reference 1

Company Name *

Contact Name *

Phone *

Email *

Account Number

Reference 2

Company Name *

Contact Name *

Phone *

Email *

Account Number

Reference 3

Company Name *

Contact Name *

Phone *

Email *

Account Number

4Banking Information

Bank Name *

Bank name is required.

Account Number *

Account number is required.

Routing Number *

Valid 9-digit routing number is required.

3Fleet Information

Fleet Size *

Fleet size is required.

Fleet Vehicle Makes Used

List the truck / bus makes in your fleet

Parts Categories / Brands of Interest

List the parts categories and brands you buy most

5Download & Upload Tax Forms

Download the forms below, complete them, and upload the signed copies. W-9 is required; ST-4 is optional (only needed if your business is tax-exempt).

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W-9 Form

Required by the IRS. Download, sign, and upload the completed form.

⬇ Download W-9

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Massachusetts ST-4 OPTIONAL

Only required if your business is claiming MA sales tax exemption.

⬇ Download ST-4

Upload Completed W-9 *

📎

Click to upload W-9

PDF, DOC, DOCX — max 10MB

Upload Completed ST-4 (Optional — tax-exempt only)

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Click to upload ST-4

PDF, DOC, DOCX — max 10MB

6Authorization & E-Signature

I/We certify that the information provided in this application is true, correct, and complete to the best of my/our knowledge. I/We authorize Brake & Truck Supply to verify all information provided, including contacting trade references, banks, and credit bureaus as necessary. I/We understand that this application does not guarantee credit approval and that Brake & Truck Supply reserves the right to deny credit based on the information provided or credit history. If approved, I/We agree to pay all invoices within the agreed-upon terms and understand that overdue accounts may be subject to standard collection procedures.

I have read and agree to the authorization above *

Signature Name *

Signature name is required.

Title *

Title is required.

Date *

Date is required.

Keep me updated on new parts, promotions, and fleet deals from Brake & Truck Supply

We'll review your application and respond within one business day.

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Application Received

Thank you — we'll review your credit application and be in touch within 1–2 business days.

While you wait:

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