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Credit Application

Company Information as Applicable
Legal Name			Corporation #
Trade Name			Phone
Address			Fax
City		State		Zip Code
Contact			Position
Type of Business			Years in Business
Insurance broker		Contact		Telephone
Owner / Partner / Personal Information as Applicable
Name			Phone
Address			Cell
City		State		Zip Code
Occupation			Employer
SIN			How long employed
Date of Birth			Gross monthly income
Banking Information
Bank			Contact Name
Address		State		Zip Code
Account number		Phone		Fax
Trade References
Company			Address
Contact		Phone		Fax

Company			Address
Contact		Phone		Fax

Company			Address
Contact		Phone		Fax
Other Information
A/P contact			Telephone
Reason for seeking credit	Rental Parts Service Equipment Lease Other
Purchase order required		Yes No		Amount of credit requested
You confirm that the information you have given us in respect of this application is true and complete, and you authorize us to rely on and use this information in order to confirm your identitiy, evaluate your credit worthiness, in relation to the credit being sought. In particular, you agree that we, our affiliates and any third parties acting for us or on our behalf (hereinafter collectively "us", "we" or "our"), may obtain a credit report or other credit information from any credit reporting agency, credit bureau or credit grantor, and may hold, use, exchange and disclose such information for the purposes of transacting business with Utility Trailers of New England 1-800-346-8748. If your application is approved, you authorize us to collect , hold use, exchange and disclose your personal information, as required, in order to administer, service or enforce any lease, ancillary deed or transaction including but not limited to assignments and securitizations. We will keep a file containing some or all of your personal information at the offices of Utility Trailers of New England 1-800-346-8748 You have the general right to access and rectify the personal information in this file by making a written request to our offices. Terms Net in 30 days, accounts overdue may have a S/C applied and may be placed on credit hold. If there is a default collection fees will be the responsiblility of the customer.
Position		Print Name		Date
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