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Credit App
Download Credit Application
 
Rental Agent : Anticipated Rental Date:
General Information
Contat Person:
Email:
Company Name
DBA: : Year Established:
Parent Company (if applicable):
Billing Address
City, State, & Zip:
Phone: Fax:
Credit line requested:
Pick One: Corporation LLC Partnership Individual
Have you ever filed for bankruptcy? Disposition:
Do you require the use of purchase orders or other references?
Persons authorized to place orders:
Credit & Trade References
Accounts must be open and active. Include fax #'s for application to be processed
Reference #1
Company: Phone:
Address: Fax:
City: State: Zip:
Email:

 

Reference #2

Company: Phone:
Address: Fax:
City: State: Zip:
Email:
 

Reference #3

Company: Phone:
Address: Fax:
City: State: Zip:
Email:
 
Reference #4
Company: Phone:
Address: Fax:
City: State: Zip:
Email:
 
Bank Information
Bank: Representative:
Address:
Phone: Fax:
Checking Account # : Savings Account #:
Visa / MC/ Amex #: Exp Date:
 
To Be Compleated By Corporations and LLC's Only:
President Treasurer:
Formed under the laws of which state?: Year:
Federal ID#:  
 
To Be Compleated By Indviduals and Partnerships Only:
Employer's Name: Position
Address:
City State: Zip
Phone:
Social Security Number: Drivers Lic #: Issuing State
 
Insurance Information
Insurance Agent/Broker: Phone:
Address:
Would you like information on our other services? Check all that apply
IT Rentals Engineering/ Design Services
Audio Rentals Video Rentals Postproduction Rentals
 

CERTIFICATE OF INSURANCE NAMING ATM LEASING AS A LOSS PAYEE IS REQUIRED PRIOR TO RENTAL

Most financial banking institutions, as well as other business, require a signature prior to releasing any financial information. By signing this form you acknowledge and agree that any and all credit information may be released to ATM Leasing.

In consideration of the extension of credit terms, the undersigned severally and/or collectively personally guarantees payments of all charges made by and/or on behalf of the applicant, plus attorney fees, court and all other costs of collection proceedings, should collection proceedings become necessary.

I agree to the terms and conditions described above:
Digital Signature
Full Name Date:
Title: