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Rental Credit Application
Untitled
*
New Customer
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SALES TEAM MEMBER
*
EQUIPMENT INFORMATION:
Equipment Type
*
Vans
Flatbeds
Grain Hopper
Reefers
Quantity
*
Term
*
Trailer Usage:
*
Road
Local
Storage
Additional Notes
GENERAL INFORMATION:
LEGAL BUSINESS NAME
*
US DOT NUMBER
*
DBA
*
PHONE
*
FAX
BUSINESS STREET ADDRESS
*
CITY-STATE-ZIP
*
RENT
OWN
OWNER
*
NUMBER OF YEARS
*
E-MAIL ADDRESS
*
NUMBER OF EMPLOYEES:
*
PO REQUIRED
*
YES
NO
NO. YEARS IN BUSINESS
*
A/P CONTACT
*
A/P PHONE
*
BUSINESS ADDRESS IS THE SAME AS THEIR BILLING ADDRESS
Yes
BILLING STREET ADDRESS
*
CITY-STATE-ZIP
*
TAX EXEMPT
*
YES
NO
TAX STATUS
*
INDIVIDUAL
PROPRIETORSHIP
PARTNERSHIP
CORPORATION
FEDERAL ID #
*
ANNUAL SALES #
*
NAME OF PARENT OR RELATED COMPANY:
NO. OF TRUCKS OWNED:
*
NO. OF TRAILERS OWNED:
*
INSURANCE INFORMATION:
INSURANCE AGENT
*
CONTACT
*
PHONE
*
STREET ADDRESS
*
CITY
*
STATE
*
ZIP
*
TYPE OF POLICY
*
BLANKET
REPORTING
CREDIT INFORMATION - BANK:
BANK NAME/BRANCH LOCATION
*
CONTACT
*
FAX
*
LAST 4 DIGITS of ACCT #
*
CREDIT INFORMATION - TRADE REFERENCES:
TRADE REFERENCE 1:
*
STREET ADDRESS
*
CONTACT
*
PHONE
*
TRADE REFERENCE 2
*
STREET ADDRESS
*
CONTACT
*
PHONE
*
OTHER RENTAL COMPANIES USED
# OF CURRENT RENTAL UNITS
ADDITIONAL INFORMATION:
DRIVERS LICENSE # OF SIGNATORY BELOW
*
SOCIAL SECURITY # OF SIGNATORY BELOW
*
RESIDENCE
*
RENT
OWN
STREET ADDRESS OF SIGNATORY'S RESIDENCE
*
CITY-STATE-ZIP
*
# OF YEARS
PREVIOUS ADDRESS
(PRINT NAME SIGNATURE)
(TITLE)
(DATE)
"I HEREBY CERTIFY THE INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. MO GREAT DANE RESERVES THE RIGHT TO TERMINATE LEASE UPON DEFAULT AND DEMAND PAYMENT IN FULL. MO GREAT DANE ALSO RESERVES THE RIGHT TO ACCEPT OR CANCEL THIS AGREEMENT AT THEIR DISCRETION. I AUTHORIZE A MO GREAT DANE REPRESENTATIVE TO CONTACT ANY OR ALL OF THE ABOVE BANK OR TRADE REFERENCES, AND RUN A COMMERCIAL OR PERSONAL CREDIT REPORT. THIS APPROVAL WILL ALLOW MO GREAT DANE TO UTILIZE CREDIT REPORTING AGENCIES TO OBTAIN CREDIT APPROVAL AND ANY FOLLOWUP REPORTS FOR CREDIT PURPOSES."
SIGNATURE
*
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