Tri-Lift NJ Inc. Credit Application

Company Name
Billing Address Billing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Fax Fax - ### - ### ####
Is the Shipping Address the Same?

Is the Shipping Address the Same? Yes
Shipping Address Shipping Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Fax Fax - ### - ### ####
Email
Accounts Payable Contact Name Accounts Payable Contact Name First Last
Is a P.O. required for Sales | Service | Parts | Rental?

Is a P.O. required for Sales | Service | Parts | Rental? Yes No
Type of Organization

Type of Organization Partnership Corporation Gov't Non-Profit Proprietorship Other
Operation Fleet Size

Operation Fleet Size 1-3 Units 4-6 Units 7-9 Units 10-15 Units 15+ Units
Type of Units

Type of Units Electric Gas Diesel Propane
Name of Owner(s) | Corporate Officer(s)
Month | Year Established
D & B:
State Sales Tax Status

State Sales Tax Status Exempt

*YOU MUST PROVIDE THE NECESSARY FORMS STATING YOUR TAX EXEMPTION STATUS
Please attach all necessary forms
Tax ID #

*YOU MUST PROVIDE THE NECESSARY FORMS STATING YOUR TAX EXEMPTION STATUS
I hereby certify that the information listed above and/or attached is warranted to be true. I authorize Tri-Lift NJ, Inc. to check our credit via online sources.

Should credit availability be offered, the applicant understands and agrees:

1) To pay all charges within payment terms stated on each invoice.

2) That all invoices not paid within Tri-Lift NJ, Inc. payment terms as noted on the invoices are subject to late payment fees of 1.5%per month.

3) That all necessary collection and reasonable legal fees may be charged to applicant in the event of default or failure to pay for goods sold and delivered. *

I hereby certify that the information listed above and/or attached is warranted to be true. I authorize Tri-Lift NJ, Inc. to check our credit via online sources.

Should credit availability be offered, the applicant understands and agrees:

1) To pay all charges within payment terms stated on each invoice.

2) That all invoices not paid within Tri-Lift NJ, Inc. payment terms as noted on the invoices are subject to late payment fees of 1.5%per month.

3) That all necessary collection and reasonable legal fees may be charged to applicant in the event of default or failure to pay for goods sold and delivered. I agree
Name
Title
Date Date / MM / DD YYYY
What Tri-Lift NJ Departments will you be dealing with?

What Tri-Lift NJ Departments will you be dealing with? Sales Service Parts Rental