Bosley Rental & Supply, Inc.
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| 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 ___________________ |
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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 |
| ________________ ___________________________ ________________ ___________________________ ________________ ___________________________ | ______________ ______________ ______________ |
______________ ______________ ______________ |
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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 ____________________________ |
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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) |
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| BRS Use Only: Credit Amount: _____________________________________ Approved By: _______________________________________ Rejected By: _______________________________________ Account Number: ____________________________________ |
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