OTC Fleet Services | Account Application
Please fill out all required fields appropriately down below. Information is secure and confidential. We value our clients privacy. Thank you!
Business Name
Business Address
Business Email
Business Phone Number
Type of Business
Year Established
EIN
Bank Name and Address
Tax Exempt
Select an option
Yes
No
If Tax Exempt, please provide a copy of a PA Tax Exempt Certificate.
Select a File
Email for Invoice Delivery
Preferred Payment Method
Select an option
COD
Credit Card
Check
ACH
Other?
Accounting Contact Information
First and Last Name
Email
Phone Number
Owner/Form of Contact
First and Last
Address
Phone Number
References
Please attach a file with a list of four references where you currently have a charge account. Please be sure to include business name, address, phone and account number.
Upload File for References Here
Select a File
DUN & Brad Street Number
Additional Questions
How did you hear about us? We are happy to hear from you!
What size fleet do you have?
5-15
16-30
31-50
51-100
101-150
151+
How much credit on your account are you looking for?
Anything you would like to add, please type below.
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