The A-1 COAST Companies
24000 Crenshaw Blvd., Torrance, CA 90505
(800) WE COAST (932-6278) (310) 326-1910 FAX (310)326-1547

CREDIT APPLICATION
PLEASE COMPLETE ALL FIELDS

 

Company Name:   Phone: Fax:
Billing Address:    
City State: Zip:
Shipping Address:
City State: Zip:
Type of Business: 
Contractor's Lic.#:
Proprietorship:     
  Partnership:
Corporation:        
  In state of:

PRINCIPALS/OFFICERS:

1. Name:
Title: Soc.Sec.#:
Home Address:
City: Zip: 
Phone:

2. Name:
Title: Soc.Sec.#:
Home Address:
City: Zip: 
Phone:

Bank and Branch:
Account #:
How is authorization to use account given? P.O.#:
Verbal:
Driver's License #:

Credit Line Requested $

We recommend you secure the use of your account at the A-1 COAST Companies, by providing us with a list of persons who are authorized to use your account. This list must include the person's NAME, and DRIVER'S LICENSE NUMBER. Both pieces of information are necessary to insure security. Please notify us immediately to add or delete authorized persons to charge on your account. Please fax changes on your stationery with the signature of one of the principals/officers and the date of the notification.

Add
DeleteName: Driver's License No:
Add
DeleteName: Driver's License No:
Add
DeleteName: Driver's License No:
Add
DeleteName: Driver's License No:

Credit is requested by the undersigned, who understands that the invoice amount must be paid within 30 days of invoice date. Applicant further agrees to pay all reasonable cost of collection, if any, court costs, and attorney's fees allowed by this state. I hereby declare that to the best of my knowledge, the aforementioned information is accurate, and I am responsible for the timely payment on all outstanding invoices.

Principals/Officers:
Signature:
Title: Date:
Signature:
Title: Date:


Please make certain your account information is complete and up-to-date
so that we will be able to effectively handle any orders you may place.

What or who prompted you to call A-1 Coast Rentals
for your equipment or sanitation needs?

 

 

 

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Copyright 2003, A-1 Coast Rentals Corporation
Date last revised: 05/16/2004