Credit Application Form - Access Hire Middle East

CREDIT APPLICATION FORM

General Information

Company Name: Address (Head Office): Year of Establishment: Telephone: E-mail:

Registration Details

No. of Employees: Fax: Website:

Legal Status

Establishment

Nature of Business:

Trade Licence No.:

Chamber of Commerce:

Proprietors/Partners

Limited Liability Company

Joint Venture

Issue Date: Issue Date:

Partnership

Corporation

Date of Registration:

Expiry Date:

Expiry Date:

Name of Proprietors/ Partners

Nationality

% Ownership

Position Held

Office No.

As on Date: _________________________________

Local Sponsor

Name: ______________________________________________________________________________________________________________________ Address: ____________________________________________________________________________________________________________________ Tel No.: ___________________________________ Fax: ______________________________________

Joint Venture (if applicable)

Name of the Joint Venture Company: ____________________________________________________________________________________________ Address: ____________________________________________________________________________________________________________________

Related Companies

A

Parent

Company Name

Address

Line of Business

% Shares

B

Subsidiaries

1

2 3

Auditors

Name: Address:

Access Hire Middles East

Plot 598-1124, Dubai Investments Park 1, Dubai UAE

P O box 57504, Dubai, UAE

Tel: +971 4 884 1118 1|P a g e

ISO Certificates

Number

CREDIT APPLICATION FORM

Start Date

Expiry Date

Legal Matters

1. Have you or your partners/ Shareholders/ Directors ever filed for bankruptcy? If yes, when: ___________________________________________________________

2. Is your company subject to any legal proceedings? If yes, describe: ________________________________________________________

Bank References

Yes No Yes No

1.

Bank Name: _______________________________________________________________ Tel:_______________________________________

Address: _________________________________________________________________ Fax: ______________________________________

Relationship Mgr.: __________________________________________________________________ Office No.: ________________________________

Bank Accounts:

Current

Savings Other, Specify ______________________ Email:____________________________________

2.

Bank Name: _______________________________________________________________ Tel:_______________________________________

Address: _________________________________________________________________ Fax: ______________________________________

Relationship Mgr.: __________________________________________________________________ Office No.: ________________________________

Bank Accounts:

Current

Savings Other, Specify ______________________ Email:____________________________________

Major Supplier References (Services and Materials)

1.

Company Name: _________________________________________________________ Tel: __________________________________________

Address: ________________________________________________________________ Fax: __________________________________________

Contact Name: __________________________________________________________ E-mail:________________________________________

Designation: ____________________________________________________________ Office No.: ____________________________________

Credit Period: 0 30 60 90 days Terms: Cash Credit LC Credit Limit: AED _______________________________

2.

Company Name: _________________________________________________________ Tel: __________________________________________

Address: ________________________________________________________________ Fax: __________________________________________

Contact Name: __________________________________________________________ E-mail:________________________________________

Designation: ____________________________________________________________ Office No.: ____________________________________

Credit Period: 0 30 60 90 days Terms: Cash Credit LC Credit Limit: AED _______________________________

List of On-going Projects

Client Name

1 2 3 4 Total

Project

Developer

% Complete

Finish Date

Access Hire Middles East

Plot 598-1124, Dubai Investments Park 1, Dubai UAE

P O box 57504, Dubai, UAE

Tel: +971 4 884 1118

2|P a g e

CREDIT APPLICATION FORM

Authorized Signatories to sign LPO

Full Name

1 2

Designation

Specimen Signature

Email Address

Authorized Signatories Cheques/ Bill of Exchange/ Other Bank Documents

Full Name

1 2

Designation

Specimen Signature

Email Address

Key Contact Persons for Payments Process

Full Name

1 2

Designation

Office No.

Email Address

Details of your Credit Requirement from ACCESS HIRE MIDDLE EAST

Services Required: Equipment Rental Equipment Sales Others

Specify: __________________________________

Value

_________________ _________________ _________________ _________________

_________________ _________________ _________________ _________________

_________________ _________________ _________________ _________________

Please Attach the Following Documents:

Credit Terms

0 days 30 days 60 days 90 days

0 days 30 days 60 days 90 days

0 days 30 days 60 days 90 days

1 Copy of Trade License 2 Copy of Chamber of Commerce Certificate

Job Duration __________________________________ __________________________________ __________________________________ __________________________________

__________________________________ __________________________________ __________________________________ __________________________________

__________________________________ __________________________________ __________________________________ __________________________________

Access Hire Middles East

Plot 598-1124, Dubai Investments Park 1, Dubai UAE

P O box 57504, Dubai, UAE

Tel: +971 4 884 1118 3|P a g e

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