Secured Yard Location: 9701 E. 102ND AVENUE HENDERSON, CO 80640
(970) 518-9079
CUSTOMER APPLICATION FORM
Billing: P.O. Box 200383 Evans, CO 80620 (970) 978-8573 FAX (360) 935-8573
Please complete all credit information in detail. A complete form provides information that will help us better respond to your equipment needs. If you have a question about how to complete this online application form, please contact our Customer Service Center at 1-970-518-9079. Thank you. Copies of your most recent year-end financial statements are required for all lease arrangements of 12 months or longer and for self-insurance requests. Financial statements are held in strictest confidence and will be forwarded to an All Ways Leasing, LLC regional credit manager for review. If your lease/rental transactions are tax exempt, you must return a completed tax exemption certificate for each state in which your company wants to establish an account. Thank you for your interest in doing business with All Ways Leasing, LLC. We look forward to serving you. CUSTOMER INFORMATION:
Company Legal Name ______________________________________________
Street Address: _________________________________________________ City, State and Zip Code: ____________________________________________ BILLING ADDRESS if different from Street Address: Billing Address: ___________________________________________City, State and Zip Code: __________________________________________
Phone:______________________________________________________ Fax #: ___________________________________________________________ Email: ______________________________________________________ Web Site: ________________________________________________________ President/CEO: _______________________________________________ Officer (Name & Title): ____________________________________________ BUSINESS TYPE: (Select the type that best describes your business)______Sole Proprietorship Fed ID or Tax ID Number: ___________________________________ If a Sole Proprietorship, please fill out the following information: First Name: ________________________________ Middle Name: ______________________________ Last Name: ________________________________ Date Of Birth (MM/DD/YY): ________________ Social Security Number:_____________________
_______Corporation
_______Partnership
The name shown under Sole Proprietorship must be the same individual who approved the Standard Terms and Conditions. By selecting Sole Proprietorship, you authorize All Ways Leasing, LLC to conduct a personal credit check to verify the information on this application. GENERAL BUSINESS INFORMATION: Date Operation Began (mm/dd/yyyy):_________________________________ Number of Employees: __________________ Type of Business: ____________________________________________________ Are purchase orders required to do business with your company? YES ___________ NO ____________
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CUSTOMER APPLICATION FORM (CONT.)
TAX STATUS: Is your business tax exempt? YES ___________ NO ____________
If claiming tax exempt, you must provide a Tax Exemption Certificate acceptable to All Ways Leasing, LLC HAZARDOUS MATERIAL Are you a transporter of hazardous material, refuse or waste hauler as regulated by Motor Carrier Act 1980? YES ___________ NO ____________ If yes, and MC-990 endorsement must be on your auto liability policy. Specify the type of material, refuse or waste your company hauls:______________________________________ INSURANCE REQUIREMENTS Liability Insurance: All Ways Leasing, LLC must be listed as additional insured and loss payee. Minimum liability coverage required. Commercial General Liability - $1 Million Please provide the following information: Insurance Agency/Carrier name:_______________________________________________ Contact Name: _________________________________________________ Phone Number: (Please include area code): _____________________________ Physical Damage Option A All Damage Waiver (ADW)/Fire Theft Waiver (FTW) All Ways Leasing, LLC will provide a price quote based on my company's equipment requirements. Option B Customer Provided Insurance Auto Liability - $1 Million
(Please provide the following Information:)
Insurance Agency/Carrier name:_______________________________________________ Contact Name: ________________________________________________ Phone Number: (Please include area code): ______________________________ REFERENCE INFORMATION Bank and Trade references (Please list equipment references - rent, lease or finance.)
Bank Name: ___________________________________________________ Street Address: ____________________________________________________ City, State and Zip Code: ____________________________________________ Account #: ________________________________________________________ Contact: __________________________________________________________ Phone (Include Area Code): ___________________________________________ Brief Description of Reference:________________________________________________________________ _________________________________________________________________________________________
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CUSTOMER APPLICATION FORM (CONT.)
Trade Reference Name: _____________________________________________ Street Address: ____________________________________________________ City, State and Zip Code: ____________________________________________ Account #: ________________________________________________________ Contact: __________________________________________________________ Phone (Include Area Code): ___________________________________________ Brief Description of Reference:________________________________________________________________ _________________________________________________________________________________________
Trade Reference Name: _____________________________________________ Street Address: ____________________________________________________ City, State and Zip Code: ____________________________________________ Account #: ________________________________________________________ Contact: __________________________________________________________ Phone (Include Area Code): ___________________________________________ Brief Description of Reference:________________________________________________________________ _________________________________________________________________________________________ A copy of your most recent year-end financial statement is appreciated. Financial statements are required for all lease agreements of 12 months or longer and for self-insurance requests.: Please check your information to make sure it is correct before you submit. Thank you. By signing below, (1) I represent and warrant that I am authorized to agree to the Standard Terms and Conditions on behalf of the applicant, (2) I am the individual identified above, and (3) I understand that I am agreeing to the Standard Terms and Conditions on behalf of the applicant. A copy of the Standard Terms and Conditions may be found on our company web site at http://www.AllWaysLeasingLLC.com.
Date: _________________________
By: ____________________________________________
Print: ___________________________________________
Title:___________________________________________