Credit Application

Please complete the following Credit Application. If you prefer to mail or fax your application, you can print this PDF version.

Business Contact Information
Name & Title:
Company Name:
Phone: Fax: E-mail:
Registered
Company Address:
City: State: Zip:
Date Business
Commenced:
Sole Proprietorship Partnership Corporation Other

Business and Credit Information
Primary
Business Address:
City: State: Zip:
How long at
current address?
       
Telephone: Fax: E-mail:
Bank Name:
Bank Address:
City: State: Zip:
Bank Phone:

Business/Trade References
Company Name:
Address:
City: State: Zip:
Phone: Fax:    

Company Name:
Address:
City: State: Zip:
Phone: Fax:    

Company Name:
Address:
City: State: Zip:
Phone: Fax:    

Agreement
  1. All invoices are to be paid by the 10th of the month following purchases or rent.
  2. By submitting this application, you authorize Koberstein Rental & Sales, Inc. to make inquireies into the banking and business/trade references that you have supplied.
Signature: Title:
        Date:

 

 


Koberstein Rental & Sales, Inc. - 3301 W. Broadway, Princeton, IN 47670
Phone: (812) 386-RENT - Fax: (812) 386-0317 - E-mail: rentals@kobersteins.com

 

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