Credit Application Form for a Credit Account

Shorty's Rental Center

P.O Box 5035

Midland, tx 79704

P: 432-620-9990

F: 432-620-9969

Personal Information

First Name *

Last Name *

Company Name

Address 1 *

Address 2

City *

State *

Zip Code *

Phone *

Email Address *

Driver's license number *

Expiration *

State Issued *

Date of Birth *

Tax Identification Number *

Business Type *

Sole Proprietorship

Partnership

Corporation

Other

Business & Credit Information

Physical Address 1 *

Address 2

City *

State *

Zip Code *

Phone *

Email Address *

Bank Name *

Phone *

Bank Address 1 *

Address 2

City *

State *

Zip Code *

Bank Contact *

Phone *

Address 1 *

Address 2

City *

State *

Zip Code *

Company Owners (List Name, TIN # and DOB for each) *

Credit References

Individual or Company Name *

Address 1 *

Address 2

City *

State *

Zip Code *

Phone *

Email Address *

Individual or Company Name *

Address 1 *

Address 2

City *

State *

Zip Code *

Phone *

Email Address *

Special Billing Instructions

Purchase Order Required? *

Yes

Tax Exempt *

Yes

Agreement

For the purpose of obtaining credit, I, the undersigned applicant, represent the forgoing statement to be true, correct and compete. The holder of this application may verify or authorize others to verify all information, and I agree to notify holder of any changes. This application shall remain the property of the holder.

I agree to pay all invoices on receipt or by the due date, and that all invoices will be considered past due after 30 days of the date of invoice. I agree to pay Shorty’s Rental Center as applicable all unpaid balances plus any accrued finance fees on past due balances. If not paid on demand of payment, I also agree to pay all applicable charges for services rendered to collect my past due account as well as any applicable attorney fees.

Signature *

clear

Full Name *

Title *

Date *

Guarantee

The undersigned hereby agrees to unconditionally personally guarantee payment and performance under the terms of this agreement, to the holder of this agreement, in the event the above buyer fails to do so. The undersigned hereby waives any notices regarding the agreement on this guarantee and agrees that this guarantee shall be applicable for as long as this agreement and account shall be operative. This guarantee shall for all purposed be deemed to be made in and shall be governed by the laws of the state of Texas and the county of Midland in which application has been made for approval.

I agree to the guarantee terms as set forth on the below date. *

clear

Full Name *

Title *

Date *

Attachments

Please submit a copy of your Tax Certificate *

Report abuse