Commercial Billing Account Application and Agreement
Please fill in blanks (type or print clearly). All information must be completed.
BUSINESS INFORMATION
COMPANY NAME NO. OF YRS. IN BUSINESS NO. OF EMPLOYEES
GTRIGGS 4 1
PHYSICAL ADDRESS (P.O. BOXES NOT ACCEPTED) NATURE OF BUSINESS
92 W MAIN ST UNIT 30, PLAINVILLE, CT 06062 DELIVERY/COURIER
BILLING ADDRESS PRIMARY CONTACT NAME:
92 W MAIN ST UNIT 30, PLAINVILLE, CT 06062 GARY RIGGS
CITY STATE ZIP CODE TELEPHONE NO. (NO CELL PHONES)
PLAINVILLE CT 06062 860 - 747 - 8169
PREVIOUS BUSINESS ADDRESS (IF AT PRESENT ADDRESS LESS THAN 2 YEARS) DUN & BRADSTREET NO.
126 NEW BRITAIN AVE APT U2, PLAINVILLE, CT 06062 ▬ ▬
PARENT COMPANY (IF APPLICABLE) BILLING CONTACT: (NAME AND EXTENSION)
ADDRESS CITY STATE ZIP CODE E-MAIL ADDRESS
garytriggs@griggsct.com
APPLICANT IS: PO # REQUIRED TAX EXEMPT? YES NO
Corporation Sole Proprietorship Partnership LLC Yes No If yes, please provide a copy of your tax exemption certificate.
CREDIT REFERENCES
BANK TRADE
BANK NAME NAME (1) TELEPHONE NO.
WEBSTER BANK AVANT BUSINESS SERVICES 860 - 296 - 1005
CITY STATE TELEPHONE NO. ADDRESS
PLAINVILLE CT 860 - 793 - 7815 110 Murphy Rd, Hartford, CT
CHECKING ACCOUNT NO. CONTACT CONTACT ACCOUNT NO.
13104070 Marlene Holmes Driver 1879
PREVIOUS BANK (IF LESS THAN 2 YEARS) NAME (2) TELEPHONE NO.
- -
CITY STATE TELEPHONE NO. ADDRESS
- -
CHECKING ACCOUNT NO. CONTACT CONTACT ACCOUNT NO.
AUTHORIZED TO RENT
NAME PHONE NUMBER NAME PHONE NUMBER
GARY RIGGS (860) 620 - 7144 ( ) -
( ) - ( ) -
( ) - ( ) -
FOR SOLE PROPRIETORSHIPS OR PARTNERSHIPS, THE FOLLOWING INFORMATION IS REQUIRED:
OWNER’S NAME SOCIAL SECURITY NUMBER % OWNERSHIP
GARY RIGGS 044 - 40 - 1279 100
RESIDENCE PHYSICAL ADDRESS RESIDENCE PHONE #
92 W MAIN ST, PLAINVILLE, CT 06062 (860) 620 - 7144
OWNER’S NAME SOCIAL SECURITY NUMBER % OWNERSHIP
- -
RESIDENCE PHYSICAL ADDRESS RESIDENCE PHONE #
( ) -
AUTHORIZED SIGNATURES (ADDITIONAL AUTHORIZATIONS REQUIRED FOR SOLE PROPRIETORSHIPS & PARTNERSHIPS)
I/we have read the terms and conditions on the second page and agreed thereto on behalf of the Customer. I/we certify the completed information provided in this
agreement to be correct and he/she is authorized to commit the Customer to the terms and conditions of this agreement. I/we authorize the release of any information
required by Budget Truck Rental, LLC to complete its credit investigation.
Authorized Authorized
Signature X Signature X
Print Name GARY RIGGS Print Name
Title OWNER Title
Date 12 / 05 / 2007 Date / /
*FIRST INITIAL AND LAST NAME ONLY Budget Truck Use Only
SALES PERSON* CPG D & B SCREEN COMMERCIAL BILLING ACCOUNT #
D & B BUSINESS INFO RPT
EXPERIAN INTELLISCORE
YES
ACCT. MANAGER CODE EXPERIAN BUSINESS PROFILE
NO BANK TRADES
Bud Truck (Rev. 2/07)
Commercial Billing Terms and Conditions
For the purposes of this agreement, “Customer” shall be defined as the business and/or corporation
indicated on the Commercial Billing Account Application and Agreement, and in the case of a sole
proprietorship or partnership, the individuals owning said business.
1. Customer agrees that payment is required Net 30 days from the date of the invoice. Customer
assumes full responsibility for all charges, fees, damages, and expenses incurred by itself, its
principals, employees, or agents, including, but not limited to, payment for the loss or damage to
the rental vehicle (if applicable), parking tickets and toll violations which payment is due upon
receipt of the invoice from Budget Truck Rental, LLC.
2. Customer agrees that payment is to be made by company check, electronic funds transfer (EFT),
bank check, cashier’s check, or money order. Customer further agrees that payments are to be
postmarked by the due date and sent to the specific “Remit To” address on the invoice with the
remittance advice included. Additionally, customer agrees that any payment not identified to a
specific invoice can be applied to the oldest outstanding invoice.
3. Customer agrees that in the event a check is returned for insufficient funds, payment must be made
by certified funds, including a $25.00 returned check processing fee. Customer further agrees that
payment shall be remitted within 24 hours of notification, and sent by EFT, overnight mail or
courier service.
4. Customer agrees that in the event a check for payment is returned due to having been written on a
closed account the same terms apply as in paragraph 3. Customer further agrees that the credit
billing status of the account shall be suspended and the account shall be placed on a “cash only”
rental status until a new credit application has been received and approved by the Credit
Department. In the event that Customer is not approved for a credit billing account Budget Truck
Rental, LLC may, in its sole election, open a “cash account” for the Customer’s use.
5. Customer agrees that they will be billed for insurance and/or protection products on each rental
pursuant to the Customer’s applicable selections on the Commercial Truck Rental Optional
Insurance and Protection Products form unless and until such time as an acceptable Certificate of
Insurance has been provided to, and been approved by the Insurance Verification Department of
Budget Truck Rental, LLC (See Certificate of Insurance Guidance Form)
6. Customer agrees that any disputed charges appearing on an invoice must be presented to Budget
Truck Rental, LLC, in writing, within 60 days. Customer further agrees that after 60 days, any
charges not disputed in this manner shall be deemed correct and owed by the customer.
7. Customer agrees that invoices not paid within 45 days of the date appearing on the invoice shall be
charged a 1.5% finance charge per month based on the unpaid balance and that said unpaid
balance and finance charges shall be due and payable upon demand. Customer further agrees to
pay all collections costs including, but not limited to, all costs, fees, interest, charges and
attorney’s fees incurred in the collection of any amount owed.
8. Customer agrees that the proper legal jurisdiction for the enforcement of this agreement shall be
the state of New Jersey.
9. Customer agrees that the rentals obtained pursuant to this Commercial Billing Agreement, will be
used solely for the Customer’s business and not for the personal use of the Customer, its
principals, employees, agents or any third parties.
10. Customer acknowledges that Budget Truck Rental, LLC may, in its sole discretion, modify these
terms and conditions, and/or terminate this Commercial Billing Account Agreement, at any time,
upon providing notice to Customer of such changes or termination.
11. All notices should be sent to Budget Truck Rental, LLC 300 Centre Pointe Drive, Virginia Beach,
VA 23462.