Rental Centers of America, Inc.

Transcription

1 Rental Centers of America, Inc. Credit Approval Request Form NEW ACCOUNT REVISED RCA CUSTOMER # DATE COMPANY NAME DBA OFFICE LOCATION BILLING ADDRESS CITY/STATE/ZIP TELEPHONE NO. FAX NO. DO YOU USE PURCHASE ORDERS? YES NO LIST INDIVIDUAL(S) AUTHORIZED TO SIGN ORDER(S) BELOW PRINT NAME(S) AND TITLE SPECIMEN SIGNATURE(S) BANK REFERENCES NAME OF BANK BANK ADDRESS ACCOUNT NO./TYPE TELEPHONE NO. TRADE REFERENCES (MINIMUM THREE (3) REQUIRED NAME OF FIRM ADDRESS TELEPHONE NO./FAX NO. CORPORATION S-CORPORATION PARTNERSHIP INDIVIDUAL SOLE PROPRIETOR AMOUNT OF CREDIT DESIRED $ (FINANCIAL STATEMENT REQUIRED IF REQUEST IS $1, OR MORE) FOR CORPORATIONS ONLY PRINCIPAL STOCKHOLDERS NAME(S) ADDRESS TELEPHONE NO. CITIZENSHIP Date business started under present ownership Was corporation incorporated in Guam If no, where incorporated (complete address) Business License No: Tax Identification No.

2 PARTNERSHIP OR SOLE PROPRIETOR ONLY PARTNE'R'S NAME ADDRESS TELEPHONE NO. CITIZENSHIP Date business started under present ownership Business License Number: Tax Identification No. COMPANIES WITH GOVERNMENT JOBS MUST LIST BONDING COMPANY, ADDRESS, TELEPHONE NUMBER, FAX NUMBER,BOND NUMBER, AND THE JOB LOCATION. COMPLETE PAGE THREE AND UPDATE AS NECESSARY.

3 IN CONSIDERATION OF EXTENSION OF CREDIT (SALES/RENTAL/ SERVICES on an Open Account) to the undersigned RENTAL CENTERS OF AMERICA, INC. to: APPLICANT'S NAME THE UNDERSIGNED AGREES HEREIN TO THE FOLLOWING: 1 To repay any indebtedness incurred, including a service/handling charge, where applicable upon receipt of the MONTHLY STATEMENT, no later than the 10 th of the month or within thirty (30) days from invoice date, WHICHEVER COMES FIRST. 2 TO repay a service/handling charge of two (2%) Percent per month, or a minimum of $7.00, WHICHEVER IS GREATER. 3 Each payment is applied to amounts previously billed in the following order: TO THE SERVICE/ HANDLING CHARGE(S), then to the purchase balance in the order of transaction. 4 Should a check be returned from the bank for any reason, a RETURN CHECK FEE will be billed and added to the account at the rate set by Rental Centers Of America. 5 It is understood that the use of a purchase order is for your convenience only and the terms and conditions of the rental agreement/contract is binding. IF PAYMENT IS NOT MADE AS REQUIRED AND AGREED HEREIN, THE UNDERSIGNED FURTHER AGREES THAT THE FOLLOWING TERMS ARE IN AFFECT. 1 Rental Centers Of America, Inc. may at it's option, without notice, declare the account in default, in which case the entire indebtedness including any service/handling charge(s), shall become immediately due and payable. 2 In the event that a delinquent account is placed in the hands of a licensed collector or an attorney for collection, or suit is indicated on this account, (l);(we) agree to pay, in addition to the amount of the delinquent account and service/handling charges, court costs, a collector's attorney's fee equal to 33-1/3% of said delinquent account incurred by Rental Centers Of America, Inc. SIGNED THIS DATE By: PRINT/TYPE NAME OF APPLICANT/COMPANY AUTHORIZED SIGNATURE TITLE APPLICANT MAY NOT MAKE ANY CHANGES ON THE TERMS AND CONDITIONS OF THIS APPLICATION AND AGREES TO ABIDE BY THE TERMS AND CONDITIONS OF THE RENTAL AGREEMENT/CONTRACT/ INVOICE. GUARANTY IN CONSIDERATION OF EXTENSION OF CREDIT BY RENTAL CENTERS OF AMERICA, INC. TO the APPLICANT HEREIN WHICH IS A: CORPORATION PARTERSHIP PROPRIETORSHIP INDIVIDUAL The undersigned do hereby jointly and severally guarantee payment in accordance with the above credit agreement, all obligations of the applicant(s) now due and hereinafter incurred with Rental Centers Of America, Inc. Consent is hereby given to Rental Centers Of America, Inc. and Applicant to compromise any claim any claim either in default of controverted, is hereby waved. Extension (and notice of extension) of time of payment and presentment for payment of the debts secured hereby is waved. GIVEN AND ACCEPTED THIS day of, 20 Print or Type Name Signature

4 APPLICANT MAY USE THE SPACE BELOW AS A CONTINUATION SPACE FOR INDIVIDUALS AUTHORIZED TO SIGN PURCHASE ORDERS. Print Name(s) and Title Address Cell Phone Specimen Signature(s) Applicant may use the space below as a continuation space for individuals authorized to sign purchase orders.

5 COMPANIES WITH GOVERNMENT JOBS MUST COMPLETE THE FOLLOWING: Please notify Rental Centers Of America, Inc. of all government jobs with the bonding information as they occur. It is the customers responsibility to either notate the job number on the purchase order or to notate the job number on the rental contract agreement when picking up the equipment. It is not Rental Centers Of America, Inc.'s responsibility to note this information. Estimated Date of completion Estimated Date of Completion Estimated Date Of Completion Name Of Bonding Company Complete Address Bond No. Telephone No. Fax No. Job Location Estimated Date Of Completion

6 RENTAL CENTERS OF AMERICA, INC. Applicant hereby irrevocable authorizes RENTAL CENTERS OF AMERICA, INC. to release to any person or firm requesting the same credit report indicating applicants performance with regards to any credit extended to it by RENTAL CENTERS OF AMERICA, INC. Applicant authorizes and request each of the references listed to release to RENTAL CENTERS OF AMERICA, INC. such credit and/or financial information concerning applicant as RENTAL CENTERS OF AMERICA, INC. may from time to time request. Applicant hereby waves any claim it may now have or hereafter acquire against RENTAL CENTERS OF AMERICA, INC. or any such reference, however delivered, in connection with the release of such information. A photo copy of the authorization shall be as valid for all purposes as the original. BY: PRINT/TYPE NAME OF APPLICANT/ COMPANY AUTHORIZED SIGNATURE TITLE BY: DATE: AUTHORIZED SIGNATURE ***APPLICATION CANNOT BE PROCESSED UNLESS ALL INFORMATION REQUESTED HAS BEEN FURNISHED AND ALL SPECIFIED AREAS HAVE BEEN SIGNED. Do Not Write Below This Line * For Rental Centers Of America's Use Only Bank References Trade References Gov't Bonding Co. Bond No. Other (explain) Credit Approved Credit Disapproved Credit Limit$ Approved By: Date: Title: