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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:

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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.




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