Please fill out the Credit Application 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 Chatfield Time Rentals & Sales as the certificate holder.

Are You Tax Exempt?
(If yes, please send a copy of your certificate)

Yes
No

Please List Trade References:

Reference Name #1:

Reference Address #1:

Reference Phone #1:

Reference Name #2:

Reference Address #2:

Reference Phone #2:

Reference Name #3:

Reference Address #3:

Reference Phone #3:

Bank Information

Bank Name:

Bank Address:

Contact Person at Bank:

Bank Phone:

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 Chatfield Time Rentals & Sales, Inc.

Date: