Credit Application

To apply for credit please print and complete the application.

CLARKSTOWN RENTALS 77 Route 59 East, Spring Valley, N.Y. 10977
Tel 854-356-3900 ** Fax 845-356-7138
email: kate@clarkstownrentals.com

Company Name ______________________________________________________
Company Address ______________________________________________________
 
  City State Zip Code
Billing Address ______________________________________________________
 
  City State Zip Code
Billing Contact ______________________________________________________
 
Name
 Phone Fax
Business Type: __ Sole Proprietorship  __ Partnership  __ Corporation
Federal Tax or Social Security No. ______________ Yearly Sales _____________
NUMBER OF YEARS IN BUSINESS ____________ CREDIT LINE REQUESTED $ ______________
DATE OF INCORPORATION (if applicable) _______________________
Name of Owner or Officer _______________________ Phone __________________
Name of Owner or Officer _______________________ Phone __________________
 
TRADE REFERENCES
If fax numbers are not supplied for references we will contact them by mail which will cause a delay in processing this application. In order to process this application, all areas must be completed.
Company _____________________________________ Phone __________________
Address _____________________________________ FAX __________________
 
Company _____________________________________ Phone __________________
Address _____________________________________ FAX __________________
 
Company _____________________________________ Phone __________________
Address _____________________________________ FAX __________________
 
Bank ____________________________________ Phone __________________
Address ____________________________________ FAX __________________
Account Number _______________________ Contact ________________________
 
All statements made herein are true and accurate to the best of our knowledge. We authorize the above company to make any and all inquiries necessary for action on this credit application. We hereby indemnify the above company and it's agents from any liability resulting from their credit survey.
 
Authorized Signature ____________________ Title __________ Date ___/___/___
 
Payment is personally guaranteed by:
Name _________________________________________ Title _______________________