Apply for an Account

Please complete and submit the form to apply for a charge account with us. After submitting the form, please email a W9 to PartsDepartment@MillsAutoGroup.com. If you have any questions or need any assistance feel free to call us at the number below:
800-533-5844

Business or Corporate Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Business Phone

(###)

###

####

Business Fax

Optional

(###)

###

####

Type of Business

Products and Services Provided

Year Business was Established

Is this business a franchise?

Yes

How long have you been at your current location?

Please list the name(s), address(es), and contact information for each business officer/owner

Bank Reference

Trade Reference #1

Trade Reference #2

Trade Reference #3

Credit Line Requested

Purchasing Agents

Optional

Accounts Payable Contact