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COMPANY NAME________________________________________Telephone
_(______)___________
Name____________________________________Title______________Fax_(______)______________
Business Address ______________________________City ______________St
_______Zip ________
Billing Address_________________________________City ______________St
_______Zip _________
Controller/Acct. Payable _______________________________Phone Ext
________________________
Application is :
( ) Individual ( ) Partnership ( ) Corporation ______________year
incorporated Years in Business _______
Tax
ID/Social Security Number ___________________________Type of Business
_________________
Please provide the following information for each of the partners or
Corporate Officers
Name
_________________________Title _____Name
____________________________Title _________
Address ________________________________Address
______________________________________
City
___________________St _______Zip ______City ______________________St
______Zip ______
SSN
__________________________________SSN
__________________________________________
Name
___________________________Title _____Name
__________________________Title _________
Address ________________________________Address
_______________________________________
City
_____________________St _______Zip ______City _____________________St
______Zip ______
SSN
__________________________________SSN
___________________________________________
Contractor License Number
_____________________________________________ Class ____________
Bonding Company______________________________________Telephone:(_____)__________________
Address ______________________________________City
___________________St ______Zip ______
Name
of Bank______________________________________________Account#_____________________
Address ______________________________________City
___________________St ______Zip _______
Contact________________________________________________Telephone:(_____)__________________
Purchase Order required? (
.
)Yes (
.
) No ( ) Check here if written
PO
is Required
Job name, number or other data required on invoicing (
.
)Yes (
.
) No
Specify:
________________________________________________________________________________
DAMAGE WAIVER
A
damage waiver of eight (8%) percent is added to all rentals.
The damage waiver is not insurance. It is designed to cover the
repair and/or replacement of an item which is damaged due to
circumstances beyond the control of the lessee. It does not cover
misuse, abuse or any other cause as indicated in Damage Waiver section
of your rental contract. A damage waiver is applied to all rentals
unless a Certificate of Insurance is issued by your insurance company
naming our firm as a Loss Payee or Additional insured. Coverage must
be adequate to fully cover those items rented. This Certificate of
Insurance must be in our possession prior to the rental.
CREDIT REFERENCES
(Please include two equipment rental companies)
Name
_______________________________________________Telephone:(_____)__________________
Address ______________________________________City
___________________St ______Zip ______
Name
_______________________________________________Telephone:(_____)__________________
Address ______________________________________City
___________________St ______Zip ______
Name
_______________________________________________Telephone:(_____)__________________
Address ______________________________________City
___________________St ______Zip ______
Name
_______________________________________________Telephone:(_____)__________________
Address ______________________________________City
___________________St ______Zip ______
CREDIT AGREEMENT & PERSONAL GUARANTEE
....
The undersigned hereby acknowledges and agrees that this application
is for a thirty (30) day account. It is further agreed that all bills
are due and payable on or before the tenth (10th) day of each month.
All bills not paid on or before the twenty fifth (25th) day of each
month shall incur a service charge equal to 2% per month on the unpaid
balance. All credit priviledges shall terminate when an account
becomes sixty (60) days old.
....
The undersigned agrees to pay any collection charges, including
reasonable attorney's fees and court costs incurred in connection with
collection of any past due amounts. It is further agreed that the
undersigned hereby personally guarantees all obligations to Robin
Rents Equipment, Inc. incurred by the above applicant
.
X
Signature _________________________________________
Print
Name __________________________ Title _______ Date ________ Home
Phone_(_____)_________
Home
Address____________________________________City ___________________St
______Zip ______
Please submit a list of names with drivers license numbers of those
persons authorized to use this account.
Name
_______________________ DL#__________Name
_______________________DL#____________
Name
_______________________ DL#__________Name
_______________________DL#____________
Name
_______________________ DL#__________Name
_______________________DL#____________
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