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UniRents Inc
1438 Ringwood Ave.
Haskell, NJ 07420
Tel: 800-42 RENT 1

.: Credit Application

Company Name:

Your Name:

Street Address:

City:

State:

Zip:

Billing Address:

City:

State:

Zip:

Organization Type:

Corporation Sole Proprietorship Partnership

FEIN/SSN:

Phone:

Fax:

E-mail:

Nature Of Business:

Years In Business:

Desired Credit Limit:

Corporate President:

Name:

Home Address:

City:

State:

Zip:

Home Phone:

E-mail:

Corporate Vice President:

Name:

Home Address:

City:

State:

Zip:

Home Phone:

E-mail:

Accounts Payable:

Name:

Phone:

E-mail:

Please List Those Who Are Authorized To Pick Up Equipment:

Do You Require Purchase Order Numbers? Yes No

For damage waiver exemptions - please send a certificate of insurance with UniRents as the certificate holder.

Are You Tax Exempt? Yes No
(if yes, please send a copy of your certificate)

Please List Trade References:

Name:

Address:

City:

State:

Zip:

Phone:

Name:

Address:

City:

State:

Zip:

Phone:

Name:

Address:

City:

State:

Zip:

Phone:

Bank Information:

Bank Name:

Bank Address:

City:

State:

Zip:

Contact Person At Bank:

Bank Phone:

A finance charge of 1 1/2% of the unpaid invoice will be assessed at 30 days.

I, hereby certify to the above statements and agree to abide by the credit terms set forth by UniRents, Inc.

Date:

By clicking the "Generate Printable Version", a copy of the Credit Application will be emailed to UniRents. Please print the application on the next page and sign and fax it to Unirent at 973-835-5918.