Company Name: 

Mailing Address:

 

Shipping Address:

Company Phone #:

 

Company Fax #:

A/P Contact:

 

A/P e-mail:

A/P Phone:

 

A/P Fax:

A/P Cutoff Date:

Purchase order numbers (PO#) required:

Establishment Date:

Is the company a:

Sole Proprietorship

Bank:  

Partnership

Branch:  

Corporation

Contact:

 

Phone:

 

Account #:  

 

Information about company owner(s):

Name:   Name:
Phone #:   Phone #:

Address:

 

Address:

 
Name: Name:
Phone #: Phone #:

Address:

Address:

 

Credit References - at least 3 required

Name:   Name:  
Phone #:   Phone #:  

Address:

 

Address:

 
 
Name:   Name:
Phone #:   Phone #:

Address:

 

Address:

If accepted, I personally guarantee this account and understand that the account is due and payable in full by the 10th of the following month and that the account will be subject to a 1˝% service charge (18% per annum) in the case of a delinquency. I further understand that in the event this account is turned over to an attorney for collection, that I will be personally responsible to pay a reasonable attorney’s fee and costs for collection. I am personally claiming responsibility and liability for purchases made by said business from Northend Rental & Construction Supply.

 

Name:

 

Title:

 

 

If you have any further information to submit, such as a list of authorized account users, please e-mail it to: Bookkeeping@NorthendRental.com

 

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Credit Application