Credit Application

Company Information
Company Name*:
Contact Name*:
Contact E-Mail Address*:      
Address*:
City*:
State*:
 
Zip Code*:
Phone*:
Fax*:
Year Business Established*:
Federal Employer ID*:
How did you hear about us:


Reference 1
Company Name*:
Phone*:
Fax*:
Length of Relationship (in years)*:
Contract:
High Credit Amt:
Current Balance*:
Terms/Net Pymt*:
Comments:


Reference 2
Company Name*:
Phone*:
Fax*:
Length of Relationship*:      
Contract:
High Credit Amt:
Current Balance*:
Terms/Net Pymt*:
Comments:


Bank Reference
Bank Name*:
Bank Contact:
Account Number*:
Date Opened*:
Phone*:
Fax*:
Current Balance*:
Comments:


Insurance Reference
Insurance Company:
Contact:
Phone:
 

INSURANCE REQUIREMENTS

TRAILERS USED FOR OVER THE ROAD AND LOCAL CARTAGE
Auto Liability Coverage with Prime Trailer Leasing named as Additional Insured. Covered needs to be primary with a cancellation notice of 30 days preferred. A minimum limit of $1,000,000 is required; lower limits (to $750,000 minimum) will be evaluated on an individual basis.

Physical Damage coverage with us named as Loss Payee. Applicable deductibles must be listed.

STORAGE TRAILERS
Liability coverage in the form of Auto or General Liability is required. Prime Trailer Leasing must be named as Additional Insured. Covered needs to be primary with a cancellation notice of 30 days preferred. A minimum limit of $1,000,000 is required; lower limits will be evaluated on an individual basis.

Storage trailers picked up or returned by the customer must have Auto Liability.

Physical Damage coverage with us named as Loss Payee. Coverage may be in the form of Inland Marine, Contractors Equipment or other coverage that provides comprehensive coverage for the equipment rented. Applicable deductibles must be listed.

Company name that appears as certificate holder should read:
Prime Trailer Leasing
10400 E 102nd Ave
Henderson, CO 80640