Business Contact Information

Legal Name of Company:

DBA Name:

Contact Name:

Phone:

Fax:

Email:

Registered Company Address:

Address:

City:

State:

Zip Code:

Year Company Started:

Referred By (BT Employee Name);

Fein #

# Employees:

Trailer Fleet Size:

Tax Exempt:

YesNo

Type of Business:

SOLE PROPRIETORSHIPPARTNERSHIPCORPORATION

If so please provide sales tax exemption form with credit application otherwise will be charged tax

Business and Credit Information

Ins. Agency:

Contact:

Phone #

Fax #

US DOT #

Bank Name:

Bank Address:

Phone #

City:

State:

Zip Code:

Type of Account

SAVINGSCHECKINGOTHER

Account #

Business/Trade References

Company Name:

Address:

City:

State:

Zip Code:

Phone:

Fax:

Email:

Type of Account:

Company Name:

Address:

City:

State:

Zip Code:

Phone:

Fax:

Email:

Type of Account:

Company Name:

Address:

City:

State:

Zip Code:

Phone:

Fax:

Email:

Types of Account:

Desired Services/Products

Please enter the types of services you will need, include the number of trailer(s), type of trailer(s), and duration.

Agreement

All Invoices are to be paid 10 days from the date of the Invoice.

Claims arising from invoices must be made within seven (7) working days.

By Submitting this application, you authorize Boston Trailer, LLC to make inquiries in to the banking and business/trade references that you have supplied

Signatures

Signature:

Print Name:

Title:

Date:

Contact Us

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