CREDIT APPLICATION

Thank you for your request for an account with REELS ON WHEELS UNLIMITED, INC. In order to establish an account for you we need the following information.

Company/Customer Name: 
 Amount of Credit Requested: 
Address: 
 City: 
 State: 
 Zip: 
Billing Contact: 
 Telephone #: 
 Fax: 
Type of Business: 
 In Business Since: 
 EIN#: 
 Dun & Bradstreet #: 
Type of Business:
Incorporation Date: 
 State of Incorporation: 
OFFICERS/PARTNERS RESPONSIBLE FOR BUSINESS TRANSACTIONS
Name: 
 Position: 
 City: 
 State: 
 Zip: 
Name: 
 Position: 
 City: 
 State: 
 Zip: 
Name: 
 Position: 
 City: 
 State: 
 Zip: 
CREDIT REFERENCES
Name: 
 Contact: 
 Telephone: 
Name: 
 Contact: 
 Telephone: 
Name: 
 Contact: 
 Telephone: 
SHIPPING CONTRACT
By executing the credit application, applicant acknowledges that they are authorized to make this application and allow verification of the above information. Applicant guarantees payment of all invoices when due and acknowledge that tithe entire account is not paid within 30 days a late charge of 1½% per month, APR 18% will be assessed against the balance.

Applicant is informed that REELS ON WHEELS UNLIMITED, LLC. does not maintain insurance coverage for the contents of the company that is the subject matter transported. The company shall indemnify and hold REELS ON WHEELS UNLIMITED, LLC. harmless from any and all claims as a result of the damage, loss or theft of any property of the applicant during transportation.
Company Representative:  Reels on Wheels Unlimited LLC: 
Title:  Title: 
Date:  Date: 
Reels on Wheels Unlimited LLC
POB 100, New Rochelle, NY 10804
877-576-6300