PLEASE FILL OUT THE CREDIT APP FROM US. WE WILL REPLY AS QUICKLY AS POSSIBLE.

Company Name:

Street Address:

Billing Address:

Organization Type:

Corporation Sole Proprietorship Partnership

FEIN/SSN:

Phone:

Fax:

E-mail:

Nature Of Business:

Years In Business:

Desired Credit Limit:

Home Address:

Please List Those Who Are Authorized To Pick Up Equipment:


Do You Require Purchase Order Numbers? Yes No

For damage waiver exemptions - please send a certificate of insurance with Adams Rental as the certificate holder.

Are You Tax Exempt? Yes No
(if yes, please send a copy of your certificate)

Please List Trade References:

Name: Address: Phone:

Name: Address: Phone:

Name: Address: Phone:

Bank Information:

Bank Name:

Bank Address:

Contact Person At Bank:

Bank Phone:

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A finance charge of 1 1/2% of the unpaid invoice will be assessed at 30 days.

I, hereby certify to the above statements and agree to abide by the credit terms set forth by ADAMS RENTAL INC.

Date: