Financing Application

Firm Name (Complete Legal Name)*

Parent Company, if Subsidary

Credit Limit Requested*

Type of Business*

Main Business Phone*

Main Business Fax*

Description of Business*

Tax ID #*

Years Est*

Billing Address*

City*

State/Province*

Country*

Postal Code*

Does your business or any affiliates have credit terms with any other Wastequip location?* Yes No

Which Locations?

Tax Exempt* Yes No
If Yes, please email your Tax Certificate to PartsPlaceCredit@wastequip.com or fax it to 574-946-7538.

Do you use Purchase Orders* Yes No

Owners/Partners/Officers*

Title*

Owners/Partners/Officers

Title

Owners/Partners/Officers

Title

A/P Contact*

A/P Phone*

A/P Fax*

A/P Email (for invoices)*

BANK REFERENCES: List past 5-yrs: bank name & acct #, address, phone, fax, contact name, & email address. Please provide checking account and account providing funds for order.

Bank Name*

Bank Account #*

Contact Name

Account Providing Funding

Bank Name

Bank Account #

Contact Name

Account Providing Funding

TRADE REFERENCES: Please furnish FOUR trade references and phone & fax numbers:

Name*

Email

Phone*

Fax

Name*

Email

Phone*

Fax

Name*

Email

Phone*

Fax

Name*

Email

Phone*

Fax

I agree to payment terms of Net 30-days FROM DATE OF INVOICE. In the event that the account is not paid according to the terms set forth in this application and agreement and on the invoice, the firm agrees to pay a Finance Charge of 1.5% per month on all delinquent amounts. It is also understood and agreed that shipments and freight pickup may be curtailed until the account is brought current and that all costs of collection, including reasonable attorney fees if incurred, will also be the responsibility of the firm.

I certify that all of the above information furnished is correct, that the firm is not insolvent, and that if the firm is a corporation, it is in good standing. I am authorized to bind the firm to this agreement and hereby give authorization for the above listed credit references to release any applicable credit information. I understand that current financial statements may be requested. If firm is a corporation, applicant must be an officer. If firm is a partnership, applicant must be a partner. If firm is a sole partnership, applicant must be a proprietor.

I’m interested in a rental program
I’m interested in a leasing program

Applicant Name*

Applicant Title*

Applicant Email*

Application Date*

Financing, Leasing and Rentals