Credit Application

New Customer Account | Credit Application

Do you have a pre-prepared customer data sheet you would like to provide?(Required)

Yes

No

Pre-prepared Customer Data Sheet Upload(Required)

Max. file size: 50 MB.

Company Name(Required)

Company Invoice-To (Billing) Address(Required)

Street Address Address Line 2 City State ZIP Code

Company Ship-To Address(Required)

Same as billing

Please select below why you obtained an Account Application (you may select more than one option).(Required)

New Equipment Purchase

Rental

Service

Parts

Accounts Payable Information

Accounts Payable Contact(Required)

First Last

Accounts Payable Phone(Required)

Accounts Payable E-mail(Required)

Contact Information

Person filling out this application.

Contact Name(Required)

First Last

Contact Phone Number(Required)

Contact Email(Required)

Business References

Reference 1: Company Name(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone Number(Required)

Email(Required)

Type of Account

Reference 2: Company Name(Required)

Address 2(Required)

Street Address Address Line 2 City State ZIP Code

Phone Number 2(Required)

Type of Account 2

Reference 3: Company Name(Required)

Address 3(Required)

Street Address Address Line 2 City State ZIP Code

Phone Number 3(Required)

Type of Account 3

Addition Account Information

D&B (D.U.N.S) Number (if known)

Are you TAX EXEMPT?(Required)

YES

NO

TAX EXEMPT CERTIFICATE (if applicable)(Required)

Max. file size: 50 MB.

Do you require Purchase Orders?(Required)

YES

NO

Black Equipment's standard terms of payment for all customer accounts is Net 30.(Required)

I acknowledge Black Equipment’s standard terms of payment

Do you have special procedures for invoice rounting?(Required)

Yes

No

Please explain your company's invoice routing procedure.

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New Customer Account | Credit Application

Accounts Payable Information

Contact Information

Business References

Addition Account Information

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