51 E. Plainfield Rd.
Countryside, IL 60525
Phone: (708) 352-7368
Fax: (708) 352-3761
Website: www.bensrentalandsales.com
10 % off first rental
when you open an account!








Thank you for your interest in opening an account with us. We look forward to serving your rental needs.

Please fill out this application, online below, in its entirety, print it and return via mail or fax.

Credit Application


  The information listed below will be kept in strict confidence.


 

 

I. Company Information

 

Full Name:

 

Business Address:

 

City:  State: Zip Code:

 

Tel: Fax:

 

E-mail:

 

Date Business Established:

 

Billing Address (if different than above):

 

Full Name:

 

Address:

 

City:  State:  Zip Code:

 

Tel: Fax:

 

E-mail:

 

Accounts Payable Contact:

 

  

I, (Print Name) ________________________________________, authorize release of bank account and credit information to Ben's Rental & Sales to review in consideration of establishing an account.

 

 

Signature: __________________________________  Title: ____________________________ Date: ________________

 

II.  Company Principals (Officers/Partners)

 

Full Name: Title:

 

Full Name:  Title:

 

III.  Bank References

 

Bank Name:  Address:

 

City: State:  Zip Code:

 

Tel:  Fax:

 

Type of Account:  Account #:

 

Type of Account:  Account #:

 


Credit Application


 

IV.  Credit References

 

Company Name:  Contact Name:

 

Address:

 

City: State: Zip Code:

 

Tel:Fax: Account #:

 

Company Name:  Contact Name:

 

Address:

 

City:  State: Zip Code:

 

Tel: Fax: Account #:

 

Company Name: Contact Name:

 

Address

 

City:  State:  Zip Code:

 

Tel:______________________________  Fax:______________________________  Account #:______________________________

 


 

* The above sections must be completed before your credit application can be processed.


 

V.  Does your company require purchase orders for rental contracts?   YES  NO

 

Ben's Rental and Sales offers an optional damage waiver charge of 10% of the total rental on all orders placed.  If you choose to apply the damage waiver to your account, it will cover any accidental damage to the equipment which may occur while it is in your possession.  The damage waiver does not cover loss or theft of equipment.  You are responsible for the replacement of lost or stolen items.

 

Would you like the Damage Waiver applied to your account?   YES  NO


 

Please make any additional comments or requests that will enable us to meet your billing specifications:

 


 

VI.  We certify that all of the information provided on this form is correct.  We fully understand Ben's Rental & Sales credit terms of Net 30 days from date of invoice, to be granted to our account upon credit approval and agree to the proper payment in consideration of extended credit.* With establishment of credit to our company we understand a service charge of 1.5% per month (18% annually) on all past due invoices will be applied. We further agree to pay all expenses of collection, including court costs and reasonable attorney's fees should it become necessary to refer the account to collection.

 

 

                           Completed By: _______________________________________________________(Print Name)

 

 

                           Signature: ___________________________________________________________

 

                          Title: Date: ex: 01/01/2010

 

 

* Invoices over 30 days past due are subject to a 1.5% finance charge; minimum of $5.00

PLEASE FAX THIS COMPLETED APPLICATION TO (708)-352-3761

 

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