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HomeCredit Application

CREDIT APPLICATION

Milam Equipment Rentals, LLC

Complete the form below to apply for a credit account. All fields marked with * are required. Incomplete applications will not be submitted for review.

Business Information

Legal Business Name *

DBA Name *

Business Type *

Tax ID Number (EIN) *

Years in Business *

Business Address *

City *

State *

Zip *

Business Phone *

Business Email *

Website (if applicable)

Owner / Principal Information

Full Name *

Title / Position

Social Security Number *

This information is kept strictly confidential and used only for credit verification.

Home Address

City

State

Zip

Phone Number *

Email Address *

Accounts Payable Information

AP Contact Name *

AP Phone Number *

AP Email Address *

Mailing Address for Invoices * (if different from business address)

City

State

Zip

Credit References(at least 2 required)

Reference #1 (Required)

Company Name *

Contact Person *

Phone Number *

Email Address *

Account Number (if applicable)

Reference #2 (Required)

Company Name *

Contact Person *

Phone Number *

Email Address *

Account Number (if applicable)

Reference #3 (Optional)

Company Name

Contact Person

Phone Number

Email Address

Account Number (if applicable)

Trade References(at least 2 required)

Reference #1 (Required)

Company Name *

Contact Person *

Phone Number *

Email Address *

Account Number (if applicable)

Reference #2 (Required)

Company Name *

Contact Person *

Phone Number *

Email Address *

Account Number (if applicable)

Reference #3 (Optional)

Company Name

Contact Person

Phone Number

Email Address

Account Number (if applicable)

Customer References(at least 2 required)

Reference #1 (Required)

Customer Name *

Contact Person *

Phone Number *

Email Address *

Description of Products/Services Provided *

Reference #2 (Required)

Customer Name *

Contact Person *

Phone Number *

Email Address *

Description of Products/Services Provided *

Bank Information

Bank Name *

Bank Address *

City *

State *

Zip *

Bank Contact Name *

Bank Phone Number *

Account Number(s) (optional)

Type of Account(s)

Authorization

I hereby authorize Milam Equipment Rentals, LLC to investigate the credit history of the business and/or its principals, as well as to contact the above-referenced parties for any additional information necessary to process this credit application. I certify that the information provided above is accurate and complete to the best of my knowledge.

I agree to the above authorization and certify that all information provided is accurate. *

Signature (Typed Name) *

Name (Print) *

Title *

Date *

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