Rental Credit Application "*" indicates required fields Step 1 of 6 16% TRI-STATE TRAILER RENTALS, LLC Tulsa, OK Oklahoma City, OK Fort Smith, AR N. Little Rock, AR Texarkana, AR Siloam Springs, AR Carthage, MO (918) 437-0010 (405) 440-2000 (479) 997-1111 (501) 945-0600 (870) 330-4435 (479) 373-1525 (800) 873-0010 If you have any questions about this form, please call (479) 297-6314 - Monday - Friday, 8am-5pm.Customer Name* First Last Customer Dunn & Bradstreet Number TIN or SSN* Billing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Physical Address*Please enter the physical address of your company. If none exists, please use your home address instead. Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Name* If you have someone you would like to assign as our contact for your company, please put their information here. Otherwise, please put your information again.Contact Title* Office Phone*Cell Phone*Email* FAXCounty* Please enter the County your business is registered in, or located.Description of Business* Number of Trucks*Please enter a number from 0 to 100000.Please enter the number of Trucks your company has.Number of Trailers*Please enter a number from 0 to 100000.Please enter the number of Trailers your company has.SIC code PO# Required?* Yes No Does your business require a PO#?Sales / Use tax exempt?* Yes No Tax Exempt #* Accounts Payable Contact* E-mail Address for Accounts Payable* Type of Business* Partnership Proprietorship Corporation Please select the type of business that best describes your company.State of IncorporationAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificPlease select the State in which your business is IncorporatedType of Incorporation Private Public Company in Business Since* Company Owner InformationOwner's Name* First Last Owner's SSN* Driver's License # Please enter the owner's driver's license # hereDate of Birth* MM slash DD slash YYYY Please enter the owner's date of birth.Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please enter the owner's addressNumber of Locations*Please enter a number from 1 to 100000.Please enter the number of locations your business hasCompany Website Contact Name First Last Please enter a contact name for the company owner (such as a personal assistant)Contact Title The title or position of the owner's contactContact PhoneContact FAX Bank InformationBank 1 - Name / Branch* Please enter the name of your company's bank, and branch.Bank 1 - Contact Name* First Last Please enter the name of your Bank's contact.Bank 1 - Account Number* Please enter the company's bank account number hereBank 1 - Phone*Please enter the bank's phone numberBank 1 - FAXPlease enter the FAX number to this bankBank 2 - Name / Branch Please enter the name of your company's bank, and branch.Bank 2 - Contact Name First Last Please enter the name of your Bank's contact.Bank 2 - Account Number Please enter the company's bank account number hereBank 2 - PhonePlease enter the bank's phone numberBank 2 - FAXPlease enter the FAX number to this bank Credit ReferencesTrade Name #1* Please enter the name of a company you have credit through.Contact / Title First Last Title Please enter the Contact Name and Title for this Trade Reference.PhonePlease enter the phone number for this Trade ReferenceFAXPlease enter the fax number to this trade / credit reference.Trade Name #2 Please enter the name of a company you have credit through.Contact / Title First Last Title Please enter the Contact Name and Title for this Trade Reference.PhonePlease enter the phone number for this Trade ReferenceFAXPlease enter the fax number to this trade / credit reference.Trade Name #3 Please enter the name of a company you have credit through.Contact / Title First Last Title Please enter the Contact Name and Title for this Trade Reference.PhonePlease enter the phone number for this Trade ReferenceFAXPlease enter the fax number to this trade / credit reference. Insurance InformationNotice: We require a valid current insurance certificate prior to any delivery or pickup of trailers, naming Tri-State Trailer Rentals, LLC as Additional Insured and Loss Payee.Liability Coverage: Agency / Broker* Contact* First Last Title Phone*Email* FAXPhysical Damage Coverage: Agency / Broker* Contact* First Last Title Phone*Email* FAXWe require a valid, current insurance certificate prior to any delivery of trailers. Our insurance requirements are as follows: General & Auto Liability coverage with a minimum of $1,000,000 limits Physical Damage coverage for the stated value of the trailer(s) Tri-State Trailer Rentals, LLC named Additional Insured and Loss Payee Certificate MUST include the following statement: 30-day notice of cancellation with 10-day notice for non-payment of premium. Certificate Holder: Tri-State Trailer Rentals, LLC P.O Box 52587 Tulsa, OK 74152 ADDITIONAL COMMENTSThe information given above is true and complete. Tri-State Trailer Rentals, LLC may receive from and disclose to other persons, including credit reporting agencies about Applicant and/or Business Owner's account and credit experience, and Applicant and/or Business Owner authorizes any person to release to Tri-State Trailer Rentals, LLC credit experience on Applicant and/or Business Owner made by Tri-State Trailer Rentals, LLC or any persons requested to release such information. In the case of default in payments, Tri-State Trailer Rentals, LLC shall be entitled to exercise remedies, in addition to all other rights permitted by law: To assess late fees and/or interest,To submit the debt to a collection agency, To submit the debt to all major credit bureaus, The Customer agrees to pay all costs of collection, including reasonable attorney's fees In consideration of being allowed the privilege of an open credit account, the undersigned, an authorized representative for the above named company applying for credit, hereby understands and agrees to abide by the terms and conditions of the Tri-State Trailer Rentals, LLC rental agreements, including but not limited to the following: All invoices are due and payable on the invoice date A 1 1/2% monthly service charge will be made on all past due invoices All invoices are payable as rendered All claims for adjustment must be made within 5 days from the invoice date If invoices are not paid upon receipt of the invoice, rental account privileges will cease and we will be on C.O.D. basis and a demand for the return of the rental equipment will be issued Tri-State Trailer Rentals, LLC has the right to limit the amount of credit extended Signature authorizes Tri-State Trailer Rentals, LLC to verify and/or check references, bank activity and credit information. This agreement shall be goverened by the laws of the State of Oklahoma. I have read, understand, and agree to the terms set forth above. (Must be Owner or Officer of the Company)Signature* Reset signature Signature locked. Reset to sign again Name* First Last Title Date* MM slash DD slash YYYY I do hereby personally guarantee this account with Tri-State Trailer Rentals, LLC (Must be Owner or Officer of the Company)Signature* Reset signature Signature locked. Reset to sign again Name* First Last Title Date* MM slash DD slash YYYY TRI-STATE TRAILER RENTALS, LLC P.O. BOX 52587 Tulsa, OK 74152LESSEE NAME* First Last CONTACT NAME* First Last LESSEE ADDRESS Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Accounts Payable Contact Name* First Last Accounts Payable Email* Accounts Payable Phone*I (we) hereby authorize Tri-State Trailer Rentals, LLC to automatically deduct the amount of my trailer rental invoices and/or other charges (including, but not limited to trailer repair invoices, toll fees, or fines incurred by the Lessee) from the bank account listed below. I understand my automatic payments will be withdrawn from my account on the due date each month or next business day if the due date falls on a weekend or holiday. This authorization will remain in effecct until Tri-State Trailer Rentals, LLC receives written notice 30 days in advance from me. Tri-State Trailer Rentals, LLC must be notified in writing at least 20 days prior to the next scheduled payment in order to stop the next automatic ACH draw. After this time, the next scheduled payment will draw regardless of a payoff received. However, Tri-State Trailer Rentals, LLC reserves the right to terminate this plan, with written notification to me, at any time.Financial Institution Name* Institution Phone Number*Routing Number* Account Number* Type of account* Checking Savings Scan and Upload* Drop files here or Select files Accepted file types: jpg, png, pdf, Max. file size: 256 MB, Max. files: 5. Please scan and upload the following: Copy of Driver's License(s) Voided CheckSignature* Reset signature Signature locked. Reset to sign again Date* MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.