Equipment Lease Agreement No
CUSTOMER APPLICATION FORM
Please complete all credit information in detail. A complete form provides information that will help us better respond to your equipment needs.
If you have a question about how to complete this online application form, please contact our Customer Service Center at 1-970-518-9079. Thank you.
Copies of your most recent year-end financial statements are required for all lease arrangements of 12 months or longer and for self-insurance requests. Financial statements are held in strictest confidence and will be forwarded to an All Ways Leasing, LLC regional credit manager for review.
If your lease/rental transactions are tax exempt, you must return a completed tax exemption certificate for each state in which your company wants to establish an account.
Thank you for your interest in doing business with All Ways Leasing, LLC. We look forward to serving you.
CUSTOMER INFORMATION:
Company Legal Name ______________________________________________
Street Address: _________________________________________________ City, State and Zip Code: ____________________________________________
Phone:______________________________________________________ Fax #: ___________________________________________________________
Email: ______________________________________________________ Web Site: ________________________________________________________
President/CEO: _______________________________________________ Officer (Name & Title): ____________________________________________
BUSINESS TYPE:
(Select the type that best describes your business)______Sole Proprietorship _______Corporation _______Partnership
Fed ID or Tax ID Number: ___________________________________
GENERAL BUSINESS INFORMATION:
Date Operation Began (mm/dd/yyyy):_________________________________
Number of Employees: __________________
Type of Business: ____________________________________________________
Are purchase orders required to do business with your company? YES ___________ NO ____________
CUSTOMER APPLICATION FORM (CONT.)
TAX STATUS:
Is your business tax exempt? YES ___________ NO ____________
If claiming tax exempt, you must provide a Tax Exemption Certificate acceptable to All Ways Leasing, LLC
HAZARDOUS MATERIAL
Are you a transporter of hazardous material, refuse or waste hauler as regulated by Motor Carrier Act 1980? YES ___________ NO ____________
If yes, and MC-990 endorsement must be on your auto liability policy.
Specify the type of material, refuse or waste your company hauls:______________________________________
INSURANCE REQUIREMENTS
Liability Insurance: All Ways Leasing, LLC must be listed as additional insured and loss payee. Minimum liability coverage required.
Commercial General Liability - $1 Million Auto Liability - $1 Million
Please provide the following information:
Insurance Agency/Carrier name:_______________________________________________
Contact Name: _________________________________________________ Phone Number: (Please include area code): _____________________________
Physical Damage
Option A
All Damage Waiver (ADW)/Fire Theft Waiver (FTW)
All Ways Leasing, LLC will provide a price quote based on my company's equipment requirements.
Option B
Customer Provided Insurance (Please provide the following Information:)
Insurance Agency/Carrier name:_______________________________________________
Contact Name: ________________________________________________ Phone Number: (Please include area code): ______________________________
REFERENCE INFORMATION
Bank and Trade references (Please list equipment references - rent, lease or finance.)
CUSTOMER APPLICATION FORM (CONT.)
A copy of your most recent year-end financial statement is appreciated. Financial statements are required for all lease agreements of 12 months or longer and for self-insurance requests.
Please check your information to make sure it is correct before you submit. Thank you.
By signing below, (1) I represent and warrant that I am authorized to agree to the Standard Terms and Conditions on behalf of the applicant, (2) I am the individual identified above, (3) I understand that I am personally guaranteeing payment of all lease agreements entered into by and on behalf of the company for which this application is submitted, and (4) I understand that I am agreeing to the Standard Terms and Conditions on behalf of the applicant. A copy of the Standard Terms and Conditions may be found on our company web site at .
Date: _________________________
By: ____________________________________________
Print: ___________________________________________
Title:___________________________________________
-----------------------
If a Sole Proprietorship, please fill out the following information:
First Name: ________________________________
Middle Name: ______________________________
Last Name: ________________________________
The name shown under Sole Proprietorship must be the same individual who approved the Standard Terms and Conditions.
By selecting Sole Proprietorship, you authorize All Ways Leasing, LLC to conduct a personal credit check to verify the information on this application.
Social Security Number:_____________________
Date Of Birth (MM/DD/YY): ________________
BILLING ADDRESS if different from Street Address: May we bill you via email? ______Yes ________No
Billing Address: ___________________________________________City, State and Zip Code: __________________________________________
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Secured Yard Location:
9701 E. 102ND AVENUE
HENDERSON, CO 80640
(303) 219-4396
Billing:
P.O. Box 200383
Evans, CO 80620
(303) 219-4396
FAX (360) 935-8573
Bank Name: ___________________________________________________
Street Address: ____________________________________________________
City, State and Zip Code: ____________________________________________
Account #: ________________________________________________________
Contact: __________________________________________________________
Phone (Include Area Code): ___________________________________________
Brief Description of Reference:________________________________________________________________
_________________________________________________________________________________________
Trade Reference Name: _____________________________________________
Street Address: ____________________________________________________
City, State and Zip Code: ____________________________________________
Account #: ________________________________________________________
Contact: __________________________________________________________
Phone (Include Area Code): ___________________________________________
Brief Description of Reference:________________________________________________________________
_________________________________________________________________________________________
Trade Reference Name: _____________________________________________
Street Address: ____________________________________________________
City, State and Zip Code: ____________________________________________
Account #: ________________________________________________________
Contact: __________________________________________________________
Phone (Include Area Code): ___________________________________________
Brief Description of Reference:________________________________________________________________
_________________________________________________________________________________________
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