EPG Credit Account Application

CREDIT APPLICATION

Start your application here. Let's start with your basic details about your business and operations.
Legal Name (Individual or Entity)
Doing Business As (DBA)
Legal Form of Business
Address

Street Address

Building, Suite, floor, unit

CityState / Province

Postal / Zip Code
Federal Tax ID
Year Business Established

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Business Description / Type of Business
Website
Parent Company Name
Parent Company - In Business Since

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Primary Accounts Payable Contact Name
Primary Accounts Payable Email
example@example.com
Primary Accounts Payable Phone
Please enter a valid phone number.Format: (000) 000-0000.
Are Purchase Orders Required?
Sales Tax Exempt?
Sales Tax Exempt Number
Upload Sales Tax

Upload a File

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Dun & Bradstreet (D-U-N-S) Number
Upload W-9 Form

Upload a File

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PRINCIPAL OWNER INFORMATION
Principal / Owner Name

First NameMiddle NameLast Name
Principal / Owner Phone
Please enter a valid phone number.Format: (000) 000-0000.
Principal / Owner Email
example@example.com
BANK REFERENCES
Institution Name
Bank Contact Name

First NameMiddle NameLast Name
Bank Account Type
Bank Account Number (last 4 digits)
Bank Phone
Please enter a valid phone number.Format: (000) 000-0000.
Bank Address
TRADE REFERENCES

Provide up to three suppliers or vendors you work with, or upload an existing file containing your references.
Upload Files

Browse Files

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Reference #1: Company Name
Contact Name (Reference #1)
Email (Reference #1)
example@example.com
Phone (Reference #1)
Please enter a valid phone number.Format: (000) 000-0000.
Reference #1: Address

Street Address

Building, Suite, floor, unit
CityState / ProvincePostal / Zip Code
Reference #2: Company Name
Contact Name (Reference #2)
Email (Reference #2)
example@example.com
Phone (Reference #2)
Please enter a valid phone number.Format: (000) 000-0000.
Reference #2: Address

Street Address

Building, Suite, floor, unit
CityState / ProvincePostal / Zip Code
Reference #3: Company Name
Contact Name (Reference #3)
Email (Reference #3)
example@example.com
Phone (Reference #3)
Please enter a valid phone number.Format: (000) 000-0000.
Reference #3: Address

Street Address

Building, Suite, floor, unit
CityState / ProvincePostal / Zip Code
** MUST READ & SIGN BELOW CREDIT TERMS**

The undersigned applicant (the “Applicant”) hereby authorizes: (a) [EP Rents LLC / Environmental Products Group, Inc.] (the “Company”) to obtain a credit report and other financial information (collectively, the “Credit Report”) from one or more credit reporting agencies, the Applicant’s banks, and other third parties; and (b) such agencies, banks, and/or other third parties to release the Credit Report to the Company. The Applicant hereby agrees that the Company may use the Credit Report for any lawful purpose, including, but not limited to: (i) authentication purposes; (ii) determining the Applicant’s existing debt obligations; and (iii) reviewing certain information and characteristics from the Applicant’s credit report from one or more credit reporting agencies, including, but not limited to, the number, age, type, and status of public records, such as bankruptcies and judgments.

The Applicant hereby represents that: (a) he or she is signing: (i) in his or her individual capacity if the Applicant is an individual or sole proprietor; or (ii) as an authorized representative of the Applicant if the Applicant is an entity; and (b) the information contained in this Application is true and complete. The Applicant hereby agrees that the Company may contact any third party to verify the information provided in this Application or in the Credit Report. The Applicant hereby agrees that a copy of this Application shall be valid as the original. The Company reserves the right to modify the credit terms extended to the Applicant at any time.

By signing below, I acknowledge that I have read, understand, and agree to the terms and authorizations set forth in this Application.
Signature
Signer Name

First NameLast Name
Signer Email
example@example.com
Signer Phone
Format: (000) 000-0000.
Signature Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
I acknowledge and agree that all billing-related documents, including invoices, statements, and notices, will be provided electronically as part of Environmental Products Group's paperless policy.
Should be Empty:

CREDIT APPLICATION

PRINCIPAL OWNER INFORMATION

BANK REFERENCES

TRADE REFERENCES