Date Received: RENTAL APPLICATION COMPANY INFORMATION: Company Name: Address: City, State, Zip: Phone: Fax: Website: BILLING INFORMATION: Address (if different): AP Contact: Phone: Email: Federal ID#: Type of Business/Industry: Year Established: Number of Employees: Tax Exempt: Yes PO Required: Yes Billing Preferences (subject to credit approval) Email Mail Contact Name: Phone: Email: Social Security #: Would you like to be enrolled in our automatic billing system via Credit Card (subject to credit approval) No Yes *If yes please fill in the credit card information sheet BANK REFERENCE (if attached on another form please provide a signature) Bank Name: Phone: Fax: Email: Account #: Trucks Trailers No No INSURANCE INFORMATON Company: Agent Name: Phone: EQUIPMENT CAN NOT BE RELASED WITHOUT A VAILD AND COMPLETE INSURANCE CERTFICATE – SEE EXAMPLE CERTIFICATE Company Name Owned Rented Phone Number Trade Reference #1 Trade Reference #2 Trade Reference #3 This application is submitted with an understanding that payment is due NET 30 days from invoice date (unless otherwise specified in your lease agreement). If a valid tax exemption is not on file, prior to billing, it will be applicant’s responsibility to file for a refund with the proper state tax authority to which those taxes have been remitted, and applicant is responsible for payment of taxes billed by Prime.Trailer. The undersigned herby authorizes applicant’s bank, insurance company, and other credit/business references to release such information required to establish credit with Prime Trailer, LLC. Signature: Printed Name Salesperson: Type of Equipment: Quantity: Rate: Mileage(Rate/Estimated Use): Reefer Hours: Credit Department: Approved By: Date: Terms: Deposit: Date: PRIME TRAILER USE ONLY Date Needed: Pick Up Delivery Insurance Approved By: Date: Date in BV/Trident: Date in Salesforce: Version 1.0 MONTHLY CREDIT CARD AUTHORIZATION FORM Date________ I _____________________ Authorize Prime Trailer LLC to charge my credit card on (NAME) Monthly basis for all rental, mileage, moving, and repair bills on my account. CREDIT CARD TYPE ____________________ CREDIT CARD # ____________________ CARD CV2 # ____________________ EXPIRATION DATE ____________________ BILLING ADDRESS ____________________ ____________________ BILLING ZIP CODE ____________________ NAME ON CARD ______________________ (As it appears on card) ____________________________________ SIGNATURE __________________ DATE Unless otherwise agreed upon we will charge your card at the beginning of each month after we complete our monthly billing (please note we bill rental invoices in arrears). Version 1.0 GUARANTY This Guaranty is given by the undersigned to Prime Storage, LLC d/b/a Prime TraileU as part of Equipment Rental Agreement # dated ___________________ (“Lease”) between PULPH7UDLOHU (“Lessee”). I am an officer, owner or other principal in Lessee and I hereby guaranty to Prime Trailer prompt payment of all fees, charges, and costs due under the terms of the Lease and this Guaranty. This is a continuing Guaranty and shall remain in force until released by PTL. This Guaranty shall cover any and all renewals, additions, modifications or extensions of the Lease. I agree that Prime Traielr may proceed against me individually without first proceeding against Lessee under the Lease. In the event of any default under the Lease or this Guaranty, I agree to be responsible for all of Prime Trailer’s service charges and collection costs, including attorney's fees, contingent, hourly or otherwise, whether or not suit is actually filed. Date: ______________________________________ Name: ______________________________________ Signature: ______________________________________ Version 1.0 AUTHORIZATION TO BANK TO RELEASE ACCOUNT INFORMATION TO PRIME TRAILER, LLC. PLEASE FAX THIS COMPLETED FORM TO US AT 303 467-9601 OR EMAIL TO [email protected] DATE: BUSINESS NAME: ACCOUNT NUMBER: FEDERAL ID: BANK NAME: CONTACT NAME: EMAIL ADDRESS: FAX NUMBER: YOU ARE HEREBY AUTHORIZED TO RELEASE TO ALL BANKING INFORMATION REQUESTED BY ANY AUTHORIZED AGENT OF PRIME TRAILER, LLC RELATING TO OUR ACCOUNT . THIS SHALL BE YOUR GOOD AND SUFFICIENT AUTHORITY FOR SO DOING. SINCERELY, PRINTED NAME: TITLE: SIGNATURE: FOR BANK USE: DATE ACCOUNT OPENED: AVERAGE MONTHLY BALANCE: Prime Trailer – Insurance Guidelines I. • • • • • II. • • • • III. • • • General Principles Insurance policy must be up-to-date and in force for the entire length of the lease with no lapse in coverage. Automobile and General Liability Insurance - Prime requests to be listed as Additional Insured in association with required General Liability and Automobile coverage. Physical Damage – Customer needs to have Physical Damage coverage and Prime requests to be listed as a Loss Payee in association with the physical damage coverage. 3rd Party transportation / movement of equipment – If the Prime customer hires or authorizes a 3rd party transportation company or individual to move, deliver or transport the trailer/equipment to, on or off their premise, the 3rd party must have automobile and general liability insurance and Prime requests to be listed as Additional Insured. Terms and Conditions of the Prime Trailer Leasing “Equipment Rental Agreement” is the stated policy of Prime Trailer and supersedes any other stated policy if in conflict. Trailers Used for Over The Road (OTR) and Local Cartage Automobile and General Liability – It is required that all OTR and Local Cartage customers provide proof of automobile and general liability insurance and requests Prime listed as Additional Insured. Physical Damage Coverage and Prime requests to be listed as a Loss Payee in association with the physical damage coverage. Coverage needs to be primary with a cancellation notice of 30 days preferred. Minimum limits of $1,000,000 combined single limit are required. Applicable deductibles must not exceed $1,000 for comprehensive and collision. Storage Trailers General Liability – Customer needs to provide proof of general liability insurance coverage that will cover the trailer on and off their premise and requests Prime listed as Additional Insured. Physical Damage Coverage - and Prime requests to be listed as a Loss Payee in association with the physical damage coverage. Coverage needs to be primary with a cancellation notice of 30 days preferred. Minimum limits of $1,000,000 combined single limit are required. Company name that appears on the policy should be: Prime Trailer 10400 E. 102nd Avenue Henderson, Co 80640 303 467-9600/303 467-9601 Fax Version 1.0
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