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Credit Application

Apply for an open account with Itawamba Equipment Solutions. Takes about 10 minutes. Questions? Call 662-231-9029.

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We'll review it and reach out within 1–2 business days. Your reference number is .

Need equipment sooner? Call 662-231-9029.

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Company Information

Company name *

Phone *

Street address *

Fax

City *

State *

ZIP *

Billing address is the same as above

Billing address

City

State

ZIP

Email *

Credit line sought *

Company is a *

Corporation Partnership Proprietorship L.L.C. P.L.C.

State registration no.

Federal tax ID (EIN)

Annual sales

Financial statements available? *

Yes No

Years in business *

If your business is less than five years old, a personal guarantee is required (see the last section).

Company Directors / Officers / Principals

Banking Details

Bank name *

Account #

Branch address

City / State / ZIP

Bank contact name

Phone

Trade References

Please list at least two vendors you buy from on credit.

Credit Report Authorization

For proprietors, partners, and S-corporations in the U.S.

I AUTHORIZE THE SELLER AND THEIR ASSIGNS TO OBTAIN A CONSUMER CREDIT REPORT ON MY CREDIT HISTORY.

I agree to the authorization above. *

Applicant's full name *

Title

Applicant's signature *

Sign here with your finger or mouse

Personal Guarantee

Required if the business has been operating less than five years.

THE UNDERSIGNED, FOR CONSIDERATION DO HEREBY INDIVIDUALLY AND PERSONALLY GUARANTEE THE FULL AND PROMPT PAYMENT OF ALL INDEBTEDNESS HERETOFORE OR HEREAFTER INCURRED BY THE ABOVE BUSINESS. THIS GUARANTEE SHALL NOT BE AFFECTED BY THE AMOUNT OF CREDIT EXTENDED OR ANY CHANGE IN THE FORM OF SAID INDEBTEDNESS. NOTICE OF THE ACCEPTANCE OF THIS GUARANTEE, EXTENSION OF CREDIT, MODIFICATION IN TERMS OF PAYMENT, AND ANY RIGHT OR DEMAND TO PROCEED AGAINST THE PRINCIPAL DEBTOR IS HEREBY WAIVED. THIS GUARANTEE MAY ONLY BE REVOKED BY WRITTEN NOTICE WHICH SHALL BE SENT TO THE CREDITOR'S CREDIT OFFICE BY CERTIFIED MAIL. ANY REVOCATION DOES NOT REVOKE THE OBLIGATION OF THE GUARANTORS TO PROVIDE PAYMENT FOR INDEBTEDNESS INCURRED PRIOR TO THE REVOCATION. I AUTHORIZE THE SELLER AND THEIR ASSIGNS TO OBTAIN A CONSUMER CREDIT REPORT AND TO CONTACT MY REFERENCES AS NECESSARY.

Submit I agree to sign this application electronically. My typed name and drawn signature have the same legal effect as a handwritten signature, and the information I've provided is true and complete. *

Itawamba Equipment Solutions LLC · 3555 Highway 178 E, Fulton, MS 38843 · 662-231-9029 · jordans@iesrents.com