Credit Application - Caprock Rentals

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Phone: (830) 360-9901

Email: sales@caprock-rentals.com

Address: 7039 FM 1044, St 402, Marion, TX 78155

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Credit Application

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- Step 1 of 6

Company Information

Customer Legal Name *

Trade Name (DBA)

Physical Address *

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Website / URL

Federal Tax ID *

State Entity Formed *

Company Formation *

Years in Business *

Have you ever filed for bankruptcy? *

Yes
No

Are you a subsidiary / division? *

Yes
No

If answering "yes" please complete the following.

Parent Company Name

Parent Company Phone

Parent Company Address

Address Line 1

Address Line 2

City

State

Zip Code

Parent Company Website / URL

Accounting & Invoice Processing

Purchase Order Required *

Yes
No

Job Number Required *

Yes
No

AP Contact

Name *

First

Last

Phone *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

How will you be paying? *

ACH Credit / Electronic Payment: Your company initiates payment to Caprock Rentals
Check Payment
Credit Card Payments: We accept VISA/MC/AMEX for invoices. For invoices over $2,000.00 an additional 3% charge may apply.

All invoices are subject to NET 30 terms. Invoices not paid within 30 days may be subject to a 1% per month charge.

Are you tax exempt? *

Yes
No

If you are tax exempt, please attached any necessary documents.

If you are tax exempt, please attached any necessary documents.

Click or drag a file to this area to upload.

Banking Information

Bank Name *

Phone *

Contact Name

First

Last

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Trade Reference # 1

Trade #1 Name *

Account #

Year Opened *

Account Contact *

First

Last

Contact Phone *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Trade Reference # 2

Trade #2 Name *

Account #

Year Opened *

Account Contact *

First

Last

Contact Phone *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Signatory Information / Authorized Agent

Name *

First

Last

Title / Relation to Customer *

Phone *

Email *

Date / Time *

Date

Time

Signature *

Clear Signature

I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein.

Headquarters

7037 FM 1044
Marion, TX
78124

Phone: (830) 360-9901

Email: sales@caprock-rentals.com

Private Security Contractor

Texas License #: B26262201

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