Credit Application Form
Rustler Farm Equipment Rentals
Business Name
Name
Legal Name
Business info
Owner
Partnership
Corporation
Other
E-mail contact info
example@example.com
Business Phone/Cell
Format: (000) 000-0000.
Address of Business
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Tax #
How many years in business?
0-1 Year
1-2 Years
3-4 Years
5+ Years
Mailing Address, if different then above
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gross Income
Monthly
Yearly
Refrences #1
Name first/last
Phone #
Refrences #2
Name first/last
Phone #
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Name of Accounting Person
First Name
Last Name
Accounting Email info (AP/AR)
example@example.com
Credit Card Info
credit card # visa/mastercard
expiry date/ # on back of card
Payment options
direct payment
e-transfer
cheque
other
Banking info
Bank Name
Address
City
State / Province
Postal / Zip Code
Transit number/branch #
Branch #
Transit #
I hereby agree that the information given is true, accurate and complete as of the date of this application submission.
*
Agreed
Not Agreed
Name on Signature below
First Name
Last Name
Signature
Title of Signature
example (owner/accounting etc...)
Save
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