HEART OF TEXAS EQUIPMENT RENTAL, INC

 

 

 

APPLICATION FOR CREDIT

Name

DOB

Phone

Mobile

Fax

SS#

 

 

 

 

 

 

Address

 

City

 

Texas

Zip

 

 

 

Business Name

 

Type Of Business-(Check One)

Physical Address

 

Sole Proprietorship

Corporation

Partnership

Other

Type of Business

 

How Long In Business

 

 

 

Controller/Accts Payable Contact

 

Bus Phone

 

Bus Fax

 

Purchases will be

Taxable

Yes

 

No

 

Tax Certificate/ID #

 

Principal Owner(s)

Name

Address

City

State

Zip

 

 

 

 

 

Phone

Fax

mobile

TDL#

Birth Date

 

 

 

 

 

Business and Personal References

1.

Name

Address

City

State

Zip

 

 

 

 

 

Phone

Fax

mobile

How Long?

 

 

 

 

2.

Name

Address

City

State

Zip

 

 

 

 

 

Phone

Fax

mobile

How Long?

 

 

 

 

3.

Name

Address

City

State

Zip

 

 

 

 

 

Phone

Fax

mobile

How Long?

 

 

 

 

4.

Name

Address

City

State

Zip

 

 

 

 

 

Phone

Fax

mobile

How Long?

 

 

 

 

                                         

 BY SIGNING THIS, IT IS UNDERSTOOD, THAT IF APPROVED, THE TERMS OF THE CONTRACT WILL BE PAYMENT DUE NET 30 DAYS.  ALL PAST DUE ACCOUNTS WILL BE CHARGED INTEREST AT THE HIGHEST RATE ALLOWED BY LAW.  I AUTHORIZE “HEART OF TEXAS RENTAL” PERSONNEL OR AGENTS EMPLOYED BY HEART OF TEXAS RENTAL TO OBTAIN ANY INFORMATION THEY MAY REQUIRE FROM CREDIT AGENCIES, RELEVANT BUSINESSES AND REFERENCES CONCERNING THIS APPLICATION AND FURTHER STATE THAT ALL OF THE ABOVE IS TRUE AND COMPLETE. 

Authorized Signature

 

Title

Date

Print Name

 

 

 

Please Print this application and fax to 1-830-868-9201

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