* Required
  *Please indicate which branch you would like to pick up at:
  Seattle    Portland    Hayward    Stockton    Fontana
  Pico Rivera    Phoenix    Dallas    Houston    Laredo
  GENERAL INFORMATION:
*BUSINESS NAME
*PHONE
FAX
*PHYSICAL ADDRESS         RENT____OWN____

*OWNER

*E-MAIL ADDRESS

*CITY-STATE-ZIP         *NUMBER OF YEARS

*A/P CONTACT & PHONE #

*NO. YEARS IN BUSINESS

*BILLING ADDRESS
*PO REQUIRED
__YES    __NO
*TAX EXEMPT    __YES    __NO
If tax exempt please fill our Resale certificate provided.
*CITY-STATE-ZIP
*NUMBER OF EMPLOYEES
__ INDIVIDUAL           __ PROPRIETORSHIP
__ PARTNERSHIP     __ CORPORATION
ADDITIONAL LOCATIONS (IF MORE THAN ONE PLEASE PROVIDE ADDRESS(S))
*FEDERAL ID #
*ANNUAL SALES #
NAME OF PARENT OR RELATED COMPANY
      N/A
*NO. OF TRUCKS OWNED
MC/USDOT#
*NO. OF TRAILERS OWNED
DO YOU USE OWNER/OPERATORS    
__ YES      __ NO
ARE YOU AN OWNER/OPERATOR    
__ YES      __ NO

  INSURANCE INFORMATION:
*INSURANCE AGENT
*CONTACT
*PHONE
*ADDRESS
*CITY-STATE-ZIP
*TYPE OF POLICY
        __ BLANKET      __ REPORTING

  CREDIT INFORMATION - BANK:
*BANK NAME/BRANCH LOCATION
*CONTACT
*PHONE/FAX
*LAST 4 DIGITS of ACCT #

  CREDIT INFORMATION - TRADE REFERENCES:
*TRADE REFERENCE
*ADDRESS
*CONTACT
*PHONE
*TRADE REFERENCE
*ADDRESS
*CONTACT
*PHONE
OTHER RENTAL COMPANIES USED

NUMBER OF CURRENT RENTAL UNITS

  ADDITIONAL INFORMATION:

*DRIVERS LICENSE # OF SIGNATORY BELOW
*SOCIAL SECURITY # OF SIGNATORY BELOW
*RESIDENCE  OWN____RENT____   
PREVIOUS ADDRESS                 # OF YEARS

CITY

STATE

ZIP



I HEREBY CERTIFY THE INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. MCKINNEY RESERVES THE RIGHT TO TERMINATE LEASE UPON DEFAULT AND DEMAND PAYMENT IN FULL. MCKINNEY ALSO RESERVES THE RIGHT TO ACCEPT OR CANCEL THIS AGREEMENT AT THEIR DISCRETION. I AUTHORIZE A MCKINNEY REPRESENTATIVE TO CONTACT ANY OR ALL OF THE ABOVE BANK OR TRADE REFERENCES, AND RUN A COMMERCIAL OR PERSONAL CREDIT REPORT. THIS APPROVAL WILL ALLOW MCKINNEY TO UTILIZE CREDIT REPORTING AGENCIES TO OBTAIN CREDIT APPROVAL AND ANY FOLLOWUP REPORTS FOR CREDIT PURPOSES.

By checking this box, I agree to an electronic credit application and to the Mckinney Trailer Rentals terms as stated above.


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