Credit Application Step 1 of 5 20% Business InformationBusiness Name:* Tax Exempt:*SelectYesNoTax exempt upload:Max. file size: 100 MB.Address* Street Address City State ZIP / Postal Code Billing Address:* Street Address City State ZIP / Postal Code Business Phone:*Business Fax:*Email:* Accounts Payable contact:Federal ID#:* Contractors' Lic#: Business Type:*ProprietorshipCorporationLLCPartnershipOther(Specify Below)If Other please specify: Nature of Business:*No. of Employees:* Purchase Order Required:*SelectYesNoYears in Business:* Monthly Statement Required:*SelectYesNo Principal Owners or OfficersName* First Last Date of Birth: MM slash DD slash YYYY Title: Home Phone:Social Security #: Home Address: Street Address City State ZIP / Postal Code Name First Last Date of Birth: MM slash DD slash YYYY Title: Home Phone:Social Security #: Home Address: Street Address City State ZIP / Postal Code Name First Last Date of Birth: MM slash DD slash YYYY Title: Home Phone:Social Security #: Home Address: Street Address City State ZIP / Postal Code Bank ReferenceBank name:* Address* Street Address City State ZIP / Postal Code Account #:* Contact:* Phone No.:*Fax No.: Credit References:Business Name:* Address:* Street Address City State ZIP / Postal Code Contact:* Phone No:*Fax No:Business Name: Address: Street Address City State ZIP / Postal Code Contact: Phone No:Fax No:Business Name: Address: Street Address City State ZIP / Postal Code Contact: Phone No.:Fax No.: Terms of CreditAll amounts outstanding are due and payable by you (the "Customer") to Equipment East (the "Company") within 30 days of invoice date. All amounts not paid when due shall accrue interest at lesser of: 2% per month, or highest rate permitted by law. Any account with delinquent balance may be placed on a credit hold and Company may recover the applicable equipment or exercise such other rights or remedies that it may have under applicable law. Failure to make payment promptly in accordance with this or any other agreement with the Company will entitle the Company to apply for relief under any construction, mechanic's or builder’s lien law, or any with other applicable state law. Preliminary lien notices and mechanics lien will be filed when necessary or required by state law. Customer shall be responsible for and agrees to pay all costs, fees and expenses (including but not limited to attorneys' fees) incurred by Company in enforcing these terms or collecting amounts due. The undersigned warrants that all information listed on this application is correct, has read, accepted and agrees to be personally bound by all stated terms and conditions set forth herein and each rental contract or agreement entered into by the undersigned or its agents, representatives or employees. The undersigned agrees and consents to allow Company to verify any credit investigation needed for action on this credit application and hereby indemnifies from any liability resulting from their credit survey. It is also acknowledged and agreed that accounts receivable information may be reported by the Company to various consumer and commercial credit agencies. If this Credit Application is returned via email, the parties intend to execute this with an electronic signature with the intent to be bound. Electronic Signature:* Date* MM slash DD slash YYYY Personal GuaranteeThe undersigned hereby guarantees the full, prompt and unconditional payment to Company of all amounts due under any rental contract or agreement entered into by or for the Customer named above, when and as such amounts shall be due, and the full, prompt and unconditional performance of each and every term and condition of every transaction and agreement to be kept and performed by such Customer under such contracts or agreements with Company. This guarantee is a primary obligation of the undersigned and shall be a continuing inexhaustible guarantee without limitation as to amount or duration and may not be revoked except by notice in writing by the undersigned to an authorized officer of Company and received by Company at least thirty (30) days prior to the date set for such revocation. No such notice shall affect the undersigned's liability under this guarantee for any contract, agreement or other transaction entered into, made to or committed to be made to the Customer by the Company occurring prior to the effective date of revocation. If this credit Application is returned via email, the parties intend to execute this with an electronic signature with the intent to be bound. Electronic Signature:* Date:* MM slash DD slash YYYY CAPTCHA
