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Firm Name
Phone Number
Fax Number
Address Line
City
State
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Email Address
 
Type of Business

Corporation Individual

Year Established
Name of Bank
Owners or Officers

Title

Title
Person to Contact regarding Payments
Trade References:
Please List Rental Companies

Name Phone
Address
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Name Phone
Address
City State Zip

 

Name Phone
Address
City State Zip

   
Who is Authorized to make Purchases and Rentals

Name Name

Name Name

   
Are Purchase Orders Required Yes No
Taxable to State of North Carolina Yes No
If Tax Exempt,Please fax a copy of your Sale Tax Certificate to 1-252-446-2511
   
 


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