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IN-STOCK TRAILERS
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Credit App
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Credit App
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Rental Credit Application
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New Customer
Returning Customer
Sales Team Member
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EQUIPMENT INFORMATION
Equipment Type
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Quantity
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Term
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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
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E-Mail Address
*
Number Of Employees
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PO Required
*
YES
NO
No. Years In Business
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A/P Contact
*
A/P Phone
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Business Address is the same as Billing Address
Yes
Billing Street Address
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City-State-Zip
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Tax Exempt
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YES
NO
Tax Status
*
INDIVIDUAL
PROPRIETORSHIP
PARTNERSHIP
CORPORATION
Federal ID #
*
Annual Sales ($)
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Name Of Parent Or Related Company
No. Of Trucks Owned
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No. Of Trailers Owned
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INSURANCE INFORMATION
Insurance Agency
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Contact Name
*
Phone
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Street Address
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City
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State
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ZIP
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Type Of Policy
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BLANKET
REPORTING
CREDIT INFORMATION - BANK
Bank Name/branch Location
*
Contact Name
*
FAX
*
Last 4 Digits Of Acct #
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CREDIT INFORMATION - TRADE REFERENCES
Trade Reference 1
*
Street Address
*
Contact Name
*
Phone
*
Trade Reference 2
*
Street Address
*
Contact Name
*
Phone
*
Other Rental Companies Used
# Of Current Rental Units
ADDITIONAL INFORMATION
Drivers License # Of Signatory Below
*
Social Security # Of Signatory Below
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Residence
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RENT
OWN
Street Address Of Signatory's Residence
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City-State-Zip
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# Of Years
Previous Address
Print Name Signature
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Title
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Date
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MM slash DD slash YYYY
"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
Signature
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