Company Name: ________________________ Phone: ( )_____________________

Address: _______________________________FAX: ( )_____________________
Contact
City: _______________Zip Code: __________ Person: __________________________
Type of Business: Corporation:___ Partnership:___ Sole Proprietorship:___

Business Formed: Date: ________________ State: ______________________________
State Contractor's
License Number: _____________________ Date Issued: _____________

Federal Tax ID #:_____________________ Business SIC Code:____________________
PRINCIPAL OFFICERS OR OWNERS: (Required Information)

Name: ___________________________ Title: _____________SS#:____-____-_____

Driver's License #: _________________ State of Drivers License: _______________

Name: ___________________________ Title: _____________SS#:____-____-_____

Driver's License #:_________________ State of Drivers License: ________________
TRADE REFERENCES (Prefer Rental Companies):

Name: ___________________Tele:( )______________FAX( )______________

Name: ___________________Tele:( )______________FAX( )______________

Name: ___________________Tele:( )______________FAX( )______________
EMPLOYEES AUTHORIZED TO RENT (Required): Please add additional names to the bottom of this Credit Application.

Name: __________________ Name: __________________Name: __________________

Name: __________________ Name: __________________Name: __________________

INSURANCE (We require a certificate of insurance from your liability insurance carrier naming Cal U-Rent of Thousand Oaks, Inc. as loss payee):

Liability Insurance Carrier: _______________________________

Policy #: ____________________________ Expiration Date: ______________________
DAMAGE WAIVER is optional coverage for physical damage to our equipment and is 10% of the rental charges for non-truck items. Truck charges depend on the size. Do you wish automatic coverage? YES: ______
CAL U-RENT ACCOUNT INFORMATION:
Purchase Order Required? YES: _____ Job # Required? YES: _____
Are you Bonded with California? YES: _____ Amount of Bond? $_____________

Monthly Credit Limit Applied For: $____________
Types of trucks & equipment needed for rental:
BANKING INFORMATION: Please use the attached Bank Disclosure Authorization for each bank holding your accounts. We need written authorization from you allowing your bank to release account information to us. If you desire expedited handling, please FAX the Bank Disclosure Authorization and this Credit Application to our Business Office at 805-371-9486. Also, please mail these originals to our Business Office for our files. Thank you
I, the undersigned, represent that the information provided is for the purpose of obtaining credit and that all information is true and correct. I understand that it is illegal to willfully submit false information for the purpose of obtaining credit. I agree to rent according to the terms and conditions stated on both sides of the Cal U-Rent rental contract and any addendums thereto. Additionally, I agree to pay all invoices in-full according to the credit & payment terms of Cal U-Rent. I also agree to pay finance charges of 18% annual interest on all contracts that are unpaid 30 days or more after the date of contract closure. I further agree to pay all charges and attorney fees associated with collection of any unpaid invoice, contract or damages incurred to trucks or equipment. My signature below represents a personal guarantee of the payment for these obligations and that I am an authorized signatory for this company.

Printed Name: __________________________ Title: __________________________

Date: __________________ Signature: _____________________________
CAL U-RENT USE ONLY:

Assigned Account #: _________________ Credit Limit: $______________

Date: ______________ Approved By: _____________________________

FORM REVISED JUNE 2003