Credit Application

* required field

Applicant Information

Legal Name *
DBA (if applicable)
Fed Tax ID #
Physical Address *
City *
State *
Zip *
Phone *
Fax
E-mail *
Business Type *
A/P Contact *
	Check if you require PO numbers
Type of Equipment you want to rent or purchase?
Credit Amount Requested *
Which company will you be renting/purchasing from?
	Discount-Equipment.com , Inc.
	Power To Go
Which location will you be renting/purchasing from?
	West Palm Beach
	Online

Personal/Principal Contact Information

First Contact (required)
Name *
Title
Address *
City *
State *
Zip *
Driver's License # *
Social Security # *
Date of Birth *
Second Contact
Name
Title
Address
City
State
Zip
Driver's License #
Social Security #
Date of Birth

Bank Information

Business or Personal Checking or Savings
Bank *
Contact *
City/State *
Phone *
Account # *

Trade References

1. Name *
1. Phone *
1. Fax
2. Name *
2. Phone *
2. Fax
3. Name *
3. Phone *
3. Fax
4. Name *
4. Phone *
4. Fax

Credit References

1. Name *
1. Address *
1. Phone *
1. Account *
2. Name *
2. Address *
2. Phone *
2. Account *

Applicant Signature

The following authorization(s) shall apply to this application & subsequently for the purposes of update, renewal or extension of such credit & for reviewing or collecting the resulting account. A photostatic or facsimile copy of this authorization shall be valid as the original. BUSINESS Credit Information: Authorization for Disclosure Applicant hereby authorizes the release of credit information to Discount-Equipment.com, Inc. or its designee (and any affiliates, assignees or potential assignees thereof) from and source including credit bureau reporting agencies and applicant's bank. Hereby represent that all of the information contained in this credit application is true, correct and complete. Applicant agrees to be held liable for the debts and pay all collection costs, including attorneys' fee and/or collection agency fees in addition to any additional fees on all delinquent accounts. Authorization for Disclosure: Applicant hereby authorizes Discount-Equipment.com, Inc. or its designee (and any affiliates, assignees or potential assignees thereof) to execute and file any UCC financing statements in its name upon approval of the application.
Electronic Signature (please type name)
Business Signature *
PERSONAL Credit information: Authorization for Disclosure By signing below, the undersigned individual who is either a principal of the credit applicant or a personal guarantor of its obligations, provides written instruction Discount-Equipment.com, Inc. or its designee (and any affiliates, assignees or potential assignees therefore) authorizing review of his/her personal credit profile from a national credit bureau. I agree to be held personally liable for the debts and pay all collection costs, including attorneys and/or collection agency fees in addition to any additional applicable fees on all delinquent accounts.
Electronic Signature (please type name)
Personal Signature *
ECOA NOTICE: the Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract.) because all or part of the applicant's income derives from any public assistance or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law is the Federal Trade Commission, Equal Credit Opportunity, Washington DC 20580. If your application for business credit is denied or conditionally approved, you have the right to a written statement of the specific reasons for the denial or the conditional approval. To obtain the statement, please contact Discount-Equipment.com, Inc. at 990 West 15th Street, Riviera Beach, FL 33404 within 60 days from the date you are notified of such denial or condition. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement.

Personal Guaranty

In consideration of the extension of credit to the applicant named herein, the undersigned jointly severally and unconditionally guarantee and promise to pay all amounts now owing on which may hereinafter become owing by the applicant to Discount-Equipment.com, Inc. This is a continuing guaranty and obligations arising hereunder shall not be affected by any change in terms of indebtedness, the extension of credit beyond amounts specified herein, a change in the term of time for payment, a change in the form of indebtedness or the acceptance of security or collateral. Discount-Equipment.com, Inc. shall not be required to exhaust any remedies against applicant prior to exercising rights granted hereby. The undersigned hereby waives (1) notice of acceptance of this guaranty and of extension of credit by Discount-Equipment.com, Inc. to the applicant; (b) presentment and demand for paying of any indebtedness of the applicant; (c) protest and notice of dishonor or default to the undersigned with respect to any indebtedness of the applicant; (d) all other notices to which the undersigned might otherwise be entitled; (e) any demand for payment under this guaranty; (f) benefit of all exemptions and homestead laws; (g) all set-offs and counterclaims. This is a guaranty of payment and not of collection and the undersigned further waives any right to require that any action be brought against the applicant or any other person or to require that resort be had to any security. The undersigned agrees that, with or without notice or demand, the undersigned shall reimburse Discount-Equipment.com, Inc. to the extent that such reimbursement is not made by the applicant, for all expenses (including counsel fees) incurred by Discount-Equipment.com, Inc. in connection with any indebtedness of the applicant or the collection thereof, and will pay attorneys' fees if this guaranty is placed with an attorney for enforcement of collection from the undersigned. The undersigned personal guarantor, recognizing that his or her individual credit history may be a necessary factor in the evaluation of this personal guarantee, hereby consents to and authorizes the use of a consumer credit report on the undersigned by Discount-Equipment.com, Inc. from time to time as may be needed in the credit evaluation process. If any provision or part of any provision of this guaranty is in conflict with any applicable statue or rule of law, then such provision, or part thereof, as the case may be, shall be deemed null and void to the extent that it may conflict therewith, but without invalidating the remaining provisions hereof or the remaining part of such. THE APPLICANT HEREBY WAIVES THE RIGHT TO A JURY TRIAL OF ANY DISPUTES WHICH MAY ARISE IN CONNECTION WITH THIS GUARANTY. The applicant further acknowledges and represents that any titles written near his/her signature is/are merely intended to clarify the individual's position with the customer and in no way is intended to limit or cancel the personal nature of this guaranty.
Electronic Signature (please type name)
Signature *

For questions or assistance with this credit application, please call
561-964-4949 ext 207

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