BECK EQUIPMENT, INC Preble Rd, Preble, NY Toll Free: (866) / Fax: (607)

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1 Legal Company Name BECK EQUIPMENT, INC. RENTAL APPLICATION To apply for rentals from Beck Equipment, Inc., please provide the following information. Fill out completely and return by fax to (607) Trade Name Corporation Partnership Proprietorship D/B/A Years Established Main Office Mailing Address Main Office Physical Address City County State Zip Phone Fax Cell Federal Tax ID # Address: Years at Present Location Is Applicant a Subsidiary Or Division Of Another Business Entity? If Yes, Give Name And Address Of Parent Entity: Name Address City State Zip Phone Fax Have you ever: Been denied credit? Declared bankruptcy? Do you have a history of bad credit? PRINCIPALS: 1). First Name Middle Initial Last Name Home Address City, State, ZIP SS#: 2). First Name Middle Initial Last Name Home Address City, State, ZIP SS#: Principal Bank Address Account Type Bank Contact Name City State Zip Phone CREDIT REFERENCES: Trade Reference Name Location Phone # Fax # Trade Reference Name Location Phone # Fax # Trade Reference Name Location

2 Phone # Fax # Page 1 of 5

3 PAYMENT TERMS: Unless different terms are expressly agreed in writing, signed by a Corporate Officer of Beck Equipment, Inc. Applicant aggress to pay Beck Equipment, Inc. for all goods and services supplied to the applicant within 30 days of the invoice date. Rentals of equipment must be paid in advance. Beck Equipment, Inc. reserves the right to assess a 1.5% interest charge per month / 18% per annum or the maximum rate permitted by law on each past due amount, plus all collection costs including attorney s fees incurred with or without legal action, customer agrees to pay all such amounts. Beck Equipment, Inc. reserves the right to register any and all liens pursuant to the applicable legislation. ALL CHECKS MUST BE MADE PAYABLE TO: Beck Equipment, Inc. NOTE: If purchases are tax exempt, exemption certificates must be returned with credit application and updated annually. CREDIT TERMS: Beck Equipment, Inc. may unilaterally grant and revoke any credit without prior notice and may stop work or shipment, or may require payment in advance or COD. A service charge of $30.00 (minimum) will be applied to ALL NSF checks. DISCLOSURE: The undersigned authorizes Beck Equipment, Inc. to conduct a credit investigation in connection with the credit hereby applied for, or any renewal or extension thereof, and further agrees to the disclosure of any credit information concerning the application to or by any credit reporting agency or anyone with whom the applicant has, or proposes to, have financial relations. The applicant further agrees to notify Beck Equipment, Inc. in writing within five (5) days of any change of business name, trade name, ownership, principals, address, telephone, or other facts set forth in this application. We agree to pay all accounts within the terms established by Beck Equipment, Inc. The applicant acknowledges that Beck Equipment, Inc. reserves the right to withdraw credit privileges at any time. I / We certify that all information given in this application is true and accurate and that ( I / We) are duly authorized to bind the applicant: Full Business Name Authorized Name Title Authorized Signature Date Page 2 of 5

4 1. Name Of Job Where Equipment Will Be Used Complete Property Address Of Job 2. Name Of General Contractor For Job Complete Address Of General Contractor For Job Contact Name Contact Number 3. Name Of Owner Of Job Complete Address Of Owner Of Job Contact Name Contact Number 4. Name of Property Owner Complete Address of Property Owner Contact Name Contact Number 5. Detailed Directions to and Exact Location of Equipment FAX a copy of map with detailed directions. Page 3 of 5

5 PERSONAL GUARANTEE FROM (Individual): In consideration of the extension of credit by: Beck Equipment, Inc. of, TO: DEBTOR: City of State of, I,, City of, State of, make this guaranty as follows: I guarantee full payment for merchandise purchased from creditor by debtor. This guaranty is a continuing guaranty and shall continue and remain in full force and effect until written notice of revocation has been received by creditor. Such revocation shall not affect the guaranty, as to merchandise purchased by debtor prior to receipt of such notice of revocation, but shall be effective as to all merchandise purchased by debtor from and after receipt of the notice of revocation. Guarantor: Dated: Page 4 of 5

6 LEASE ADDENDUM This agreement is made by and entered into on the day of, 200 by and between BECK EQUIPMENT INC., referred to as Lessor in this agreement, and, Lessee, as an addendum to ANY & ALL Subsequent Lease Agreements: Lessee,, hereby agrees that without further consent of Lessee, Lessor, BECK EQUIPMENT INC., is hereby authorized to file all financing statements, amendments, assignments, releases, terminations, and other filings of any kind and description and to provide any and all authentications and to perform all filings permitted by the Uniform Commercial Code (UCC filing). IN WITNESS WHEREOF, the parties have caused this Lease Addendum to be signed by their duly authorized representatives. Dated:, 200 BECK EQUIPMENT INC. BY: LESSEE: BY: Page 5 of 5

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