7230 Springboro Pike  Dayton, Ohio 45449
Phone: 439-0504	Fax: 439-5757

APPLICATION FOR CREDIT
Page 1 of 2

CORPORATION NAME:  ___________________________________________________
DBA: _____________________________________________________________________
BILLING ADDRESS: _______________________________________________________
SHIPPING ADRESS:  _______________________________________________________
CITY/STATE/ZIP: _________________________________________________________
PHONE: _____________________________ FAX: ______________________________
FEDERAL I.D.# ___________________________	YEARS IN BUSINESS: __________
Proprietorship _________ Partnership __________ Corporation __________

Owner’s Name: ___________________________________________________________
Authorized Purchasers: ____________________________________________________
Accounts Payable Manager: _________________________________________________

List three references with which you have had an account with for at least one year.

1. Company Name: _________________________________ Telephone: ______________
    Address: ________________________________________ Fax #: _________________
                   ________________________________________ Account #: ______________

2. Company Name: _________________________________ Telephone: ______________
    Address: ________________________________________ Fax #: _________________
                   ________________________________________ Account #: ______________

3. Company Name: _________________________________ Telephone: ______________
    Address: ________________________________________ Fax #: _________________
                   ________________________________________ Account #: ______________

7230 Springboro Pike  Dayton, Ohio 45449
Phone: 439-0504	Fax: 439-5757

APPLICATION FOR CREDIT
Page 2 of 2

Additional Information: Do You Require: 

____ P.O. Number     ____ Department Number     ____ Job Number      ____ Job Name

If you have a list of authorized signers for this account, please include the list with this application. In the event the list should change, applicant is responsible to provide an updated list to Do It Yourself Rental.

Collection Costs, Attorney Fees and Interest Rate:

The undersigned understands and agrees to terms of sale and further agrees to pay all collection costs and attorney’s fees necessary to collect past due accounts as permitted by law and interest at the monthly rate of 2% (24% annually) on all past due balances.

Name: ____________________________ Title: _________________ Date: ___________ 

Personal Guarantee:

The undersigned acknowledges extended credit to persons or company above.  The undersigned agrees to personally, individually and unconditionally guarantee the full, prompt and complete payment of all indebtedness of every kind and nature owing to Do It Yourself Rental by the above named persons or company.  The undersigned further agrees to pay all collection costs, including but not limited to, court costs, attorney fees, and filing fees as permitted by law.  

Name: ____________________________ Title: _________________ Date: ___________