Credit Application

Company Name

Phone

Billing Address

City

State

Zip Code

Fax Number

Organization Type

Corporation Partnership Proprietorship

How long in business?

Number of Employees

Invoices require Purchase Order/Job number?

Yes No

Gross Annual Revenue

Years of Ownership

Will any of your rentals be sales exempt?

Yes No

Accounts Payable Contact

First Name

Last Name

Phone Number

Credit Line Requested

Officers & Principals

President

Comptroller

Vice President

Accounts Payable

Bank Reference

Name

Phone

Address

City

State

Zip Code

Point of Contact

Title

Trade References

Company

Address

Phone

Company

Address

Phone

Company

Address

Phone

If you are a tax exempt organization, please attach an exemption form.

Acknowledgement of Terms

By submitting this application for credit at Dot's Rentals & Sales, you acknowledge the terms of payment as NET 10th of month per statement.

Submitted By

Title

Date