Bosley Rental & Supply, Inc.

Download MS Word Version of this Application

1 Bosley Avenue
Parkersburg, WV 26101
(304) 422-0407
581 Ragland Road
Beckley, WV 25801
(304) 252-9045
497 Goff Mountain Road
Cross Lanes, WV 25313
(304) 776-6000 phone
Credit Application
Date ___________________ 
Customer Name _______________________________________
Billing Address _____________________________________
City, State, ZIP Code _______________________________
Contact _____________________________________________
Phone Number ________________________________________
Type of Business ____________________________________
Years In Business ___________
(  ) Individual  (  ) Partnership
(  ) Corporation
Federal ID Number ____________
P.O. # Required? _____(Y/N)
Job # Required?  _____(Y/N)
Officer's Name Home Address Title Phone
________________    ___________________________ ________________    ___________________________ ________________    ___________________________
______________
______________
______________
______________
______________
______________
Bank Reference _____________________________________
City & State _______________________________________
Account Number _____________________________________ 
Branch _______________________
Officer ______________________
Phone ________________________
Trade Reference ____________________________________
City & State _______________________________________
Contact ______________________
Phone ________________________
Trade Reference ____________________________________
City & State _______________________________________
Contact ______________________
Phone ________________________
Trade Reference ____________________________________
City & State _______________________________________
Contact ______________________
Phone ________________________
Credit Amount Requested ____________________________
I certify that all the information on this form is correct, and that I fully understand that credit terms are Net 30 Days, and agree to honor these terms as set forth by Bosley Rental & Supply, Inc. I understand that Bosley Rental & Supply, Inc. reserves the right to curtail or cease rental and sales for accounts behind in payment. Bosley Rental & Supply, Inc. reserves the right to asses a 1.5% monthly finance charge on accounts having a balance over 30 days old. I have read and do hereby agree to abide by the terms of credit stated herein.
_________________________     _________________________       __________________
(signature)                   (title)                         (date)
BRS Use Only:
Credit Amount: _____________________________________
Approved By: _______________________________________
Rejected By: _______________________________________
Account Number: ____________________________________