Welcome to Apache Equipment Rentals!
Thank you for your interest in establishing an account with Apache Equipment Rentals. We look forward to serving your equipment needs and building a long-lasting partnership.To apply for an account, please complete the credit application and have an owner or authorized officer of your company sign it.If you prefer to submit your own credit application, please complete the Business Information section below and ensure that our Account Terms and Conditions are signed and dated. You may upload your completed credit application at the bottom of this form.
BUSINESS INFORMATION
APPLICANT BUSINESS NAME:
DBA:
OFFICE CONTACT NAME:
OFFICE TELEPHONE NO.:
Please enter a valid phone number.
Format: (000) 000-0000.
EMAIL:
example@example.com
FEDERAL TAX ID NO.:
CONTRACTORS LICENSE NO.:
NATURE OF BUSINESS:
BUSINESS INCORPORATION
Please Select
CORPORATION
LLC
PARTNERSHIP
SOLE PROPRIETOR
STATE OF INCORPORATION:
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
YEAR ESTABLISHED:
BUSINESS STREET ADDRESS:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
BILLING INFORMATION
BILLING/MAILING ADDRESS
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
A/P CONTACT NAME:
A/P PHONE NO.:
Please enter a valid phone number.
Format: (000) 000-0000.
INVOICE/AP EMAIL:
example@example.com
PO REQUIRED:
*
YES
NO
ACCOUNT STATEMENT:
EMAIL
MAIL
TAX EXEMPT?
NO
YES
UPLOAD TAX EXEMPTION FORM.
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OWNERSHIP DETAILS
OWNER/PRINCIPAL NAME:
First Name
Last Name
TITLE:
OWNERSHIP %:
HOME ADDRESS:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
HOME TELEPHONE NO:
Please enter a valid phone number.
Format: (000) 000-0000.
SOCIAL SECURITY NO.:
ADD ADDITIONAL OWNER/PRINCIPAL
*
YES
NO
ADDITIONAL OWNER/PRINCIPAL NAME:
First Name
Last Name
TITLE:
OWNERSHIP %:
HOME ADDRESS:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
HOME TELEPHONE NO:
Please enter a valid phone number.
Format: (000) 000-0000.
SOCIAL SECURITY NO.:
COMMERCIAL BANKING INFORMATION
BANK NAME:
ACCOUNT NO.:
ACCOUNT TYPE
Please Select
CHECKING
SAVINGS
BANK CONTACT NAME:
CONTACT TELEPHONE NO.:
CONTACT EMAIL
example@example.com
ADD ADDITIONAL BANK INFORMATION?
*
YES
NO
BANK NAME:
ACCOUNT NO.:
ACCOUNT TYPE
Please Select
CHECKING
SAVINGS
BANK CONTACT NAME:
CONTACT TELEPHONE NO.:
CONTACT EMAIL
example@example.com
COMMERCIAL TRADE REFERENCES-PLEASE LIST 3
1. VENDOR/SUPPLIER NAME:
VENDOR NAME
ACCOUNT NO.
CITY
STATE
Postal / Zip Code
TELEPHONE NO.:
Please enter a valid phone number.
Format: (000) 000-0000.
EMAIL:
example@example.com
2. VENDOR/SUPPLIER NAME:
VENDOR NAME
ACCOUNT NO.
CITY
STATE
Postal / Zip Code
TELEPHONE NO.:
Please enter a valid phone number.
Format: (000) 000-0000.
EMAIL:
example@example.com
3. VENDOR/SUPPLIER NAME:
VENDOR NAME
ACCOUNT NO.
CITY
STATE
Postal / Zip Code
TELEPHONE NO.:
Please enter a valid phone number.
Format: (000) 000-0000.
EMAIL:
example@example.com
ACCOUNT TERMS AND CONDITIONS
ACCOUNT TERMS AND CONDITIONS
TERMS: Apache Equipment Rentals credit terms are Net 10 days from invoice date. Apache Equipment Rentals Corp. reserves the right to charge finance fees at the rate of 18% perannum (1.5% monthly) or at the highest rate available under applicable law, to any unpaid balance that exceeds 30 days. Statements and invoices will be paid according to theterms set forth by Apache Equipment Rentals. GUARANTEE: It is fully understood and agreed that upon approval of this application and in consideration of credit being extended,the undersigned Principal(s) will unconditionally, individually, and jointly, severally guarantee full payment of any balance that is unpaid by the applicant. It is understood andagreed that the applicant will pay, to the extent permitted under applicable law, all reasonable finance fees, collection fees, attorney fees, and court cost incurred by Apache Equipment Rentals. in connection with any collection action caused by any balance that remains unpaid after 60 days from the invoice date. CERTIFICATION: I/We certify that all information on this application is correct and the listed banks and references are authorized to release appropriate information to Apache Equipment Rentals., which will be heldin confidence, necessary for credit approval and that an authorized officer, owner, partner, or representative has signed this application.
PRINT NAME:
First Name
Last Name
TITLE:
SSN:
DATE:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
AUTHORIZED SIGNATURE
*
CREDIT EMAIL
credit@apacherentals.com
Submit
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