Corporation Partnership Sole Owner

Owner/Principal
Home Address
City/ State/ Zip
Home Telephone

Reference 1:

Name
Address
City/ State/ Zip
Telephone
FAX

Reference 2:

Name
Address
City/ State/ Zip
Telephone
FAX

Reference 3:

Name
Address
City/ State/ Zip
Telephone
FAX

Bank Reference:

Name of Bank
Address
City/ State/ Zip
Telephone
Contact

Check Appropriate Boxes:

Is a Purchase Order required?	Yes No
Is a job location required?	Yes No
Are you Tax-Exempt?	Yes No

NOTE: Sales Tax must be charged unless a signed exemption certificate accompanies this application. By signing this credit application,

I agree to the following: SULLY’S RENT ALL’S billing date is the 30th of the month. Applicant agrees to make full payment by the 15th of the next month. Any amount not paid within 30 days of the billing date will be subject to a 2% service charge. I understand that service charges must be paid. If this account becomes 60 days past due, the account will be placed on a cash in advance basis immediately without notice.

To agree with the terms and conditions of the above application check the "I Agree" check box. Otherwise check the "Decline" check box. By submitting this application you are stating that the above information is accurate to the best of your knowledge.

I Accept Decline

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