7230 Springboro Pike  Dayton, Ohio 45449

Phone: 439-0504        Fax: 439-5757

 

APPLICATION FOR CREDIT

Page 1 of 2

 

 

 

CORPORATION NAME:  ___________________________________________________

DBA: _____________________________________________________________________

BILLING ADDRESS: _______________________________________________________

SHIPPING ADRESS:  _______________________________________________________

CITY/STATE/ZIP: _________________________________________________________

PHONE: _____________________________ FAX: ______________________________

FEDERAL I.D.# ___________________________ YEARS IN BUSINESS: __________

Proprietorship _________ Partnership __________ Corporation __________

 

Owner’s Name: ___________________________________________________________

Authorized Purchasers: ____________________________________________________

Accounts Payable Manager: _________________________________________________

 

List three references with which you have had an account with for at least one year.

 

1. Company Name: _________________________________ Telephone: ______________

    Address: ________________________________________ Fax #: _________________

                   ________________________________________ Account #: ______________

 

2. Company Name: _________________________________ Telephone: ______________

    Address: ________________________________________ Fax #: _________________

                   ________________________________________ Account #: ______________

 

3. Company Name: _________________________________ Telephone: ______________

    Address: ________________________________________ Fax #: _________________

                   ________________________________________ Account #: ______________

 

 

 

 

7230 Springboro Pike  Dayton, Ohio 45449

Phone: 439-0504        Fax: 439-5757

 

APPLICATION FOR CREDIT

Page 2 of 2

 

 

 

 

Additional Information: Do You Require:

 

____ P.O. Number     ____ Department Number     ____ Job Number      ____ Job Name

 

If you have a list of authorized signers for this account, please include the list with this application. In the event the list should change, applicant is responsible to provide an updated list to Do It Yourself Rental.

 

Collection Costs, Attorney Fees and Interest Rate:

 

The undersigned understands and agrees to terms of sale and further agrees to pay all collection costs and attorney’s fees necessary to collect past due accounts as permitted by law and interest at the monthly rate of 2% (24% annually) on all past due balances.

 

Name: ____________________________ Title: _________________ Date: ___________

 

Personal Guarantee:

 

The undersigned acknowledges extended credit to persons or company above.  The undersigned agrees to personally, individually and unconditionally guarantee the full, prompt and complete payment of all indebtedness of every kind and nature owing to Do It Yourself Rental by the above named persons or company.  The undersigned further agrees to pay all collection costs, including but not limited to, court costs, attorney fees, and filing fees as permitted by law. 

 

Name: ____________________________ Title: _________________ Date: ___________