Net 30 Application

Credit Information

Tax Payer ID #:*

In Business Since:*

Number of Employees:*

Annual Revenue*

Legal Structure:*

Officer's Name:*

Business Phone*

Company 1 Name:*

Company 1 Phone:*

Company 1 Fax #:

Company 1 Account #:*

Company 1 Email:*

Company 2 Name:

Company 2 Phone:

Company 2 Fax #:

Company 2 Account #:

Company 2 Email:

Company 3 Name:

Company 3 Phone:

Company 3 Fax #:

Company 3 Account #:

Company 3 Email:

Bank Name*

Checking Account #:*

Bank Phone*

Authorization*

I/We certify that all information is true and complete. This request is for a Phoenix Crane Rental Company charge account. I/We authorize Phoenix Crane Rental Company to obtain further information concerning credit and financial condition of the corporation, principal owners, proprietors or partners and to exchange or provide information with other credit grantors. I/We agree to pay the amount invoiced in full and will provide Phoenix Crane Rental Company a separate financial statement upon request. In the event Phoenix Crane Rental Company extends credit to the applicant, the applicant agrees that Phoenix Crane Rental Company may assess interest and service charges on purchaser’s outstanding account balance at a rate of 1.5% per month (18% annum). Phoenix Crane Rental Company’s payment terms are Net 30 on all accounts. The purchaser further agrees to pay all costs of collection, including 15% attorney’s fee, in the event applicants account is turned over to any attorney. It is agreed that this agreement will be governed under the law of the State of Georgia. Phoenix has the option of pursuing an action under this agreement in any court of competent jurisdiction in the State of Georgia. It is agreed that seller shall retain the title to any goods sold until payment in full has been received by seller.

Electronic Signature*