Customer Application

ALL deliveries, pickups, and relocations take one to two business days.
The customer is responsible for calling in for the pick up of equipment to stop billing.
There is a 28-day minimum rental on all equipment, except roll off dumpsters.
Equipment is billed in ADVANCE on a 28-day cycle (13 bills a year) and will be pro-rated if applicable.
Roll off dumpsters are billed on delivery and per pull.

Who is your Sales Rep?
Will this be a Personal or Business Account?
- Personal
- Business
Legal Company Name
(DBA)
EIN (if applicable)
Tax Exemption Number (if applicable)
Personal/Homeowner Name
First Last
Billing Address
Street Address Address Line 2 City State ZIP Code
Physical Address (if different than Billing Address)
Street Address Address Line 2 City State ZIP Code
Phone Number
Fax Number
Accounts Payable Name
First Last
Accounts Payable Phone
Accounts Payable Ext.
If you would like your invoices emailed to you, please enter it here:
Owners/Officers
Owner/Officer Name 1
First Last
Title
Personal Address
Street Address Address Line 2 City State ZIP Code
Phone
Owner/Officer Name 2
First Last
Title
Personal Address
Street Address Address Line 2 City State ZIP Code
Phone
Credit Reference 1
Company Name
Address
Street Address Address Line 2 City State ZIP Code
Phone
Credit Reference 2
Company Name
Address
Street Address Address Line 2 City State ZIP Code
Phone
By signing below, I state that all information given above it true to the best of my knowledge. I understand that I am financially responsible for ALL orders placed under my account. I give authorization to contact credit references list above.
Enter your digital signature as /john doe/, with "/" before and after your name.
Date*
DD dash MM dash YYYY
Once submitted, you will be directed to the Delivery Information form to complete your rental.
Phone
This field is for validation purposes and should be left unchanged.

Owners/Officers