GRAND RAPIDS CRANE CO LLC.

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Russell Fletcher
5 years ago
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1 GRAND RAPIDS CRANE CO LLC. New Customer Application Contents: 1. Index 2. Application of Credit 3. Application of Credit 4. Application of Credit Please or Fax completed form to or

2 Applicant Information: Legal Business Name Business Name (DBA) Years in operation Physical Rent [ ] Own [ ] Years at address Billing Business Phone Fax Address Nature of Business File Type: S-Corporation [ ] C-Corporation [ ] Partnership [ ] LLC [ ] Sole Proprietor [ ] PO # Required Per Invoice Yes [ ] No [ ] D.U.N.S. # Owner Information: Name Title SS# / Fed ID# Home Home Phone Driver s License # Issuing State 2

3 Bank Account Information Bank Name Phone Account Contact Fax Trade References 3

4 Credit Card Information Type of Card Visa [ ] MC [ ] Am Ex [ ] Number Exp Name on Card Being the cardholder, corporate officer, or authorized purchaser, I authorize Grand Rapids Crane CO. LLC. To charge the above credit card for balances outstanding beyond the terms granted to my company or by special request. Applicant Acceptance The undersigned represents and warrants that all information within this application is true, correct, and complete, and has read and accepted and agrees to be bound by all terms set forth in this document and as is detailed in each rental document ordered by the Applicant of their agent(s). It is further understood and agreed that the Applicant specifically agrees and consents to Grand Rapids Crane CO. LLC. Investigating credit and trade payable histories and the utilization of credit reporting services to secure this information. In order to secure this credit accommodation, the applicant authorizes the now and future use of consumer credit reports and the full and complete release of credit and account information from the bank references noted in the application. Faxed copies will be treated as originals. Printed Name and Title Personal Guarantee Only required when a credit card or D.U.N.S. # is not provided The undersigned hereby unconditionally guarantees the full and prompt payment to Grand Rapids Crane CO. LLC. when due of all indebtedness, obligations, and liabilities of the Applicant named on this Application of Credit, including all amounts currently owing and arising in the future, including any service charges, interest, attorney fees, court and collections costs. The Applicant also agrees to be personally and unconditionally bound by all terms of this Application. This guarantee will continue in full force and effect until all amounts payable by Applicant to Grand Rapids Crane CO. LLC. have been paid and the Applicant account has been terminated. The Applicant guarantor hereby waives presentment demand of payment, filing, or proof of claim, any right to require a proceeding first against the Applicant, protest notice and all demands whatsoever. The Applicant further authorizes and consents to the now and future use of personal consumer credit reports for information in support of this guarantee. Printed Name and Title SS# DOB 4

Mailing Address: City: State: Zip: (If different than above) Name: SS#: DOB: Printed Name: Title:

Mailing Address: City: State: Zip: (If different than above) Name: SS#: DOB: Printed Name: Title: C#: Page 1 of 5 PC: Revised 07/11 Salesman: FERGUSON SUPPLY COMPANY COMPANY / OWNER(S) INFORMATION: Company Name: Street Address: City: State: Zip: Business / Home Phone: Cell Phone: Fax: Email Address: