Credit Application

Application Type

Full Name: E-mail: Date Of Birth: License No. (With State + Expiration Date): S.S. Number: No. Dependents: Business Phone: Residence Phone:

Make & Model: Part: Description:

Altavista Truck & Equipment
14837 Valley Blvd. Fontana, CA 92335

Phone: (909) 355-0334 Alt Phone: (909) 355-0394 Fax: (909) 355-3967