BUSINESS CREDIT - Barco



This document includes our billing setup and credit application. Please fill out pages 2, 3, & 4. Page 5 includes a sample insurance certificate.Page 6 outlines our insurance requirements.We will need the following documents sent to us:Completed business account setup and credit application (Two payment methods if in business less than five years)A copy of your current business licenseA certificate of insurance listing BARCO Rent-A-Truck as: Additionally Insured and Loss PayeeA copy of a photo ID for the person who will be signing the rental agreementsBusiness Account SetupBilling AddressName of Business:Tax Exempt FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ?????Address:Tax Exempt Number:(Please attach copy of certificate) FORMTEXT ?????City:State:ZIP:Main Phone: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????All contacts are requiredPrimary Accounts Payable:Name: FORMTEXT ?????Title: FORMTEXT ?????Phone: FORMTEXT ?????Email: FORMTEXT ?????Name: FORMTEXT ?????Title: FORMTEXT ?????Phone: FORMTEXT ?????Email: FORMTEXT ?????Employees Authorized for Rentals:Name: FORMTEXT ?????Title: FORMTEXT ?????Phone: FORMTEXT ?????Email: FORMTEXT ?????Name: FORMTEXT ?????Title: FORMTEXT ?????Phone: FORMTEXT ?????Email: FORMTEXT ?????Name: FORMTEXT ?????Title: FORMTEXT ?????Phone: FORMTEXT ?????Email: FORMTEXT ????? Purchase order required FORMCHECKBOX Yes FORMCHECKBOX NoPayment Method: (please complete included Payment Authorization form) FORMCHECKBOX ACH (eCheck) FORMCHECKBOX Credit Card Additional Special Billing Instructions FORMTEXT ?????Business Credit ApplicationName/AddressName of Business:Tax I.D. Number FORMTEXT ????? FORMTEXT ?????Address: FORMTEXT ?????City: StateZIP:Phone: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Company InformationType of Business: In Business Since:NAICS Code (Required) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????DNB #:# of Employees: FORMTEXT ????? FORMTEXT ?????Legal Form Under Which Business Operates: Corporation FORMCHECKBOX Partnership FORMCHECKBOX Proprietorship FORMCHECKBOX If Division/Subsidiary, Name of Parent Company: In Business Since: FORMTEXT ????? FORMTEXT ?????Name of Company Principal Responsible for Business Transactions: Title: FORMTEXT ????? FORMTEXT ?????Address: City:State:ZIP:Phone: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Bank ReferencesInstitution Name:Institution Name: FORMTEXT ????? FORMTEXT ?????Checking Account #: FORMTEXT ?????Savings Account #: FORMTEXT ?????Address: FORMTEXT ?????Address: FORMTEXT ?????Phone: FORMTEXT ?????Phone: FORMTEXT ?????Trade References (3 required)Company Name:Company Name:Company Name: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Contact Name:Contact Name:Contact Name: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Address:Address:Address: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Phone: FORMTEXT ?????Phone: FORMTEXT ?????Phone: FORMTEXT ?????Email: FORMTEXT ?????Email: FORMTEXT ?????Email: FORMTEXT ?????Fax: FORMTEXT ?????Fax: FORMTEXT ?????Fax: FORMTEXT ?????Account Opened Since: FORMTEXT ?????Account Opened Since: FORMTEXT ?????Account Opened Since: FORMTEXT ?????Credit Limit: FORMTEXT ?????Credit Limit: FORMTEXT ?????Credit Limit: FORMTEXT ?????Current Balance: FORMTEXT ?????Current Balance: FORMTEXT ?????Current Balance: FORMTEXT ?????I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein. FORMTEXT ????? FORMTEXT ?????Print NameAuthorized SignatureDate* A monthly recurring late fee of 3% will be added to all past due balances *Payment AuthorizationName of Business: FORMTEXT ?????XAutomatic recurring monthly charge on the 1st of each monthACH (eCheck): Bank Name: FORMTEXT ?????Name on Account: FORMTEXT ?????Bank Account Type: FORMCHECKBOX Business Checking FORMCHECKBOX Personal Checking FORMCHECKBOX SavingsBank Contact: FORMTEXT ?????Phone: FORMTEXT ?????Bank ABA Routing Number FORMTEXT ?????Account Number FORMTEXT ?????*Please attach a copy of voided check*Credit Card:Name on Card: FORMTEXT ?????Card Type: FORMCHECKBOX Visa FORMCHECKBOX Master Card FORMCHECKBOX American Express FORMCHECKBOX DiscoverCredit Card # FORMTEXT ?????Expiration FORMTEXT ?????/ FORMTEXT ?????CVV/CID FORMTEXT ?????Billing Address Street:City:ST:Zip: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Email Receipt to: FORMTEXT ?????Please note, a 3% convenience fee will be added to any payments processed by credit card.This payment authorization is valid and will remain in effect through the end of the rental contract or until I notify Barco Rent A Truck of its cancellation by email at AR@ or by calling 800-453-4761. FORMTEXT ????? FORMTEXT ?????Print NameAuthorized SignatureDate* A $35 service fee will be charged for declined credit cards or payments returned as NSF. A monthly recurring late fee of 3% will be added to all past due balances. *-522435-140335000Company must provide a certificate of insurance reflecting coverage and provisions indicated in these Insurance Requirements and on the provided, Sample Certificate.Certificate holder must reflect the same renter found on the rental agreement.Insurance Agent contact information must be listed on the certificate.The policy must reflect BARCO Rent-A-Truck as Additional Insured.The policy must include a Waiver of Subrogation in favor of BARCO Rent-A-Truck.Auto liability with a Combined Single Limit of at least $1,000,000.00 for bodily injury and property damage.Renter must insure the rental for up to the value of the vehicle as stated on page two of the rental agreement, with a maximum deductible of $1,000. The deductible needs to be shown on the certificate of Insurance.BARCO Rent-A-Truck must be specified as a Loss Payee regarding rented vehicles.Auto liability coverage must be Primary and Non-Contributory.The following verbiage must be included in the description of operation:ALL VEHICLES RENTED FROM BARCO RENT-A-TRUCK ARE INSURED ON THE COMMERCIAL AUTO POLICY NOTED ABOVE FOR THE COMPREHENSIVE AND COLLISION PHYSICAL DAMAGE, EQUAL TO THE VALUE SHOWN IN THE RENTAL AGREEMENT.BARCO Rent-A-Truck will receive 30-Day Notice of Cancellation and 30-Day Notice of NonrenewalRequired Insurance as stated on BARCO’s Rental Agreement: During the entire term of this Agreement, Renter, at your sole cost and expense, shall procure and continue in force insurance with respect to Vehicle to cover (a) property damage and bodily injury combined (based on primary coverage and excess or “umbrella coverage” combined) for not less than $1,000,000 per occurrence, and (b) collision, fire, theft and comprehensive coverage in the amount equal to the value of Vehicle as shown on Page 1 (with a maximum deductible acceptable to us), listing BARCO as Loss Payee and Additional Insured. Provided, however, that the insurance provided for above shall not limit in any way your liability under this Agreement. Such insurance shall be based on Renter’s own coverage, and not in combination with any coverage we may carry. Such insurance shall require that BARCO be given at least 10 days advance written of any cancellation, reduction or other material change in coverage, and agree to separate from any notice BARCO may receive from the insurance company, you will provide us with at least 10 days advance written notice of any cancellation, reduction or other material change in coverage. You will provide us with whatever written proof of the required coverage we request.Insurance Certificates can be submitted via:FedEx or Regular Mail: BARCO Rent-A-Truck; 717 South 5600 West; Salt Lake City, UT 84104Email: insurance@Fax: (877) 865-2316 ................
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