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.
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II.
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III.
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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