Please select how you would like to apply

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Application for a New Credit Account

Date

Address

City

State

Telephone Number

Email Address

Type of Business

Proprietorship Corporation

Year Incorporated

Name of Primary Contact

Federal Identification Number

Company Legal Name

Zip Code

Fax Number

Confirm Email Address

Partnership LLC

Year Established

Cell Phone

We Are in the Business of

Owners Information

First Name

Title

Home Phone

Last Name

SSN/SIN

Cell Phone

First Name

Title

Home Phone

Last Name

SSN/SIN

Cell Phone

First Name

Title

Home Phone

Last Name

SSN/SIN

Cell Phone

Has application or any owners ever filed for bankruptcy?

Yes No

Business or Personal?

If Yes, When?

Name of Business

If Yes, Explain

Bank Information

Bank Name

Address

City

State

Telephone Number

Bank Contact

Account Number

Zip Code

Fax Number

Insurance Informaton

Company Name

Address

City

State

Telephone Number

Email Address

Zip Code

Fax Number

Trade References

Reference 1

Reference Name

City

State

Address

Telephone Number

Email Address

How Long

Zip Code

Fax Number

Reference 2

Reference Name

City

State

Address

Telephone Number

Email Address

How Long

Zip Code

Fax Number

Reference 3

Reference Name

City

State

Address

Telephone Number

Email Address

How Long

Zip Code

Fax Number

Reference 4

Reference Name

City

State

Address

Telephone Number

Email Address

How Long

Zip Code

Fax Number

Authority to Order Equipment

Are Jobs Required?

Yes No

If YES,

Before Renting Written Verbal

Are Purchase Orders Required?

Yes No

If YES,

Before Renting Written Verbal

Anyone representing themselves as an employee of your company, verbally.

Anyone presenting a written purchase order

Others

Open Account Credit Terms

THIS APPLICATION COVERS ALL CURRENT AND FUTURE AUTHORIZED PURCHASES AND RENTALS BY SIGNING BELOW OR ACCEPTING ANY EQUIPMENT, APPLICANT AGREES TO ALL OF THE TERMS AND CONDITIONS IN THIS AGREEMENT AND ON ALL RENTAL CONTRACTS.

AUTHORITY TO CONFIRM INFORMATION AND OBTAIN CREDIT REPORTS

Applicant hereby authorizes TRINITY to obtain credit, financial and personal information of any kind concerning customer from any source. The CUSTOMER authorizes TRINITY, to investigate CUSTOMER’S credit history either in connection with this application for credit or later in connection with an update, renewal or extension of additional credit under this agreement. The CUSTOMER further authorizes TRINITY, to furnish information concerning CUSTOMER’S accounts to consumer reporting agencies and others who in TRINITY’S discretion may properly receive such information.

Applicant agrees to repayment in accordance with TRINITY’S terms (30 Days) and to a service charge of 2% per month on past due account. In the event of legal action, I agree to reimburse TRINITY for costs of collection, including reasonable attorney’s fees and court costs. (PLEASE SEE RENTAL AGREEMENT FOR FULL TERMS AND CONDITIONS)

By checking this box, I authorize my signature and hereby agree to the Credit Terms and conditions listed on this application for a new credit account; in addition, I hereby authorize the bank named above to release information requested for the purpose of obtaining and/or reviewing credit.

Company

Title

Signature

Name

Thank You

Your application has been submitted. A representative will contact you after your submission has been reviewed.