VIP Contractor Program Application »

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Thank!you!for!considering!joining!our!VIP!Contractor!Program!!!This!is!a!specially!
tailored!program!for!contractors!who!prefer!to!do!business!on!a!cash!basis,!but!need!
the!same!competitive!pricing!and!priority!service!of!a!commercial!account.!
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Advantages*of*joining*the*VIP*Contractor*Program*
• 5%!standing!discount!off!all!rental!fees!
• ‘Credit!Card!on!File’!system!
• Send!your!employees!in!to!rent!on!your!behalf!
• Priority!delivery!–!VIP!members!take!a!priority!position!on!deliveries!
• Purchase!Order!and!Job!Site!identification!on!all!paperwork!
• Ability!to!waive!Damage!Protection!charges!
• Expanded!RentalOPurchase!Option!
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For!full!program!details,!please!visit!our!website!under!“Programs”.!
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Please!return!the!completed!application!to:!
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Fax:!! 404O237O9515!
Email:!Arlene@NorthsideToolRental.com!
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We!strive!to!turn!account!applications!around!in!24!hours!or!less.!!We!will!contact!
you!promptly!when!your!account!is!established.!
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VIP CONTRACTOR PROGRAM APPLICATION
NORTHSIDE TOOL RENTAL, INC – JO & JIM, INC – MILI, INC
COLLECTIVELY REFERRED TO AS, AND DOING BUSINESS AS:
NORTHSIDE TOOL RENTAL
PLEASE PRINT – ALL INFORMATION MUST BE COMPLETED
PERSONAL & COMPANY INFORMATION:
LAST NAME:
FIRST NAME:
MIDDLE:
CITY:
STATE:
ZIP:
HOME PHONE:
CELL PHONE:
SSN:
DRIVERS LICENSE NUMBER:
STATE OF DRIVERS LICENSE:
EXPIRATION OF DRIVERS LICENSE:
HOME STREET ADDRESS:
PERSONAL EMAIL ADDRESS:
LEGAL COMPANY NAME IN FULL:
FEIN:
TRADE NAME, DOING BUSINESS AS, (IF DIFFERENT THAN ABOVE):
CONTACT NAME:
STREET ADDRESS:
MAILING ADDRESS (IF
DIFFERENT):
PHONE:
FAX:
DO YOU CURRENTLY RENT FROM OTHER COMPANIES?
YES
EMAIL ADDRESS:
NO
IF YES, WHICH ONE(S)?
WHAT TYPE OF EQUIPMENT DO YOU RENT MOST OFTEN?
ARE YOU INTERESTED IN OUR CREDIT CARD ON FILE PROGRAM?
YES
NO
CREDIT CARD AUTHORIZATION: (FOR NTR’S CREDIT CARD ON FILE PROGRAM ONLY)
I,
, HEREBY AUTHORIZE
FOR ALL CHARGES TO PURCHASE OR RENT PROVIDED EQUIPMENT:
DRIVER’S LICENSE NUMBER
IF YES, PLEASE FILL OUT THE SECTION BELOW
NORTHSIDE TOOL RENTAL TO USE THE FOLLOWING CREDIT CARD TO PAY
NAME ON DRIVER’S LICENSE
THE CREDIT CARD I AM USING TO PAY IS:
VISA
MASTERCARD
(AT THIS TIME, WE CANNOT ACCEPT DEBIT CARDS FOR THIS PROGAM. IT MUST BE AN ACTUAL CREDIT CARD)
AMERICAN EXPRESS
CARDHOLDER NAME AS APPEARS ON CARD
CREDIT CARD NUMBER
CARD BILLING ADDRESS
CARD BILLING ZIP - REQUIRED
AUTHORIZATION NAME
(PRINTED)
EXP DATE
AUTHORIZATION SIGNATURE
DISCOVER
CID
(AM EX 4 DIGITS
MC/VI/DI 3 DIGITS)
(SIGNED)
CARDHOLDER MUST RETURN FORM IN PERSON TO A BRANCH LOCATION WITH THE ABOVE CREDIT CARD IN HAND FOR IMPRINT FOR A COPY TO BE MADE OF THE CREDIT CARD AND
DRIVER’S LICENSE.
TERMS AND CONDITIONS:
THE UNDERSIGNED DOES HEREBY DOES CERTIFY THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND HEREBY AUTHORIES ANY
CREDIT INVESTIGATION NEEDED FOR VERIFICATION PURPOSES IN ACCORDANCE WITH THE FAIR CREDIT REPORT ACT, PUBLIC LAW 9-508. NORTHSIDE TOOL RENTAL RESERVES THE RIGHT TO
MODIFY THIS PROGRAM AT ANY TIME.
NAME (PRINT)
NORTHSIDE TOOL RENTAL
CORPORATE OFFICE:
SIGNATURE
35 IRBY AVE, NW
ATLANTA, GA 30305
DATE
VOICE: 404-237-9515
FAX: 404-237-8993
EMAIL TO: ACCOUNTS@NORTHSIDETOOLRENTAL.COM
OFFICE USE ONLY
STORE:
ACCT OPENED:
EMPLOYEE:
CUSTOMER #:
VIP CONTRACTOR PROGRAM APPLICATION
NORTHSIDE TOOL RENTAL, INC – JO & JIM, INC – MILI, INC
COLLECTIVELY REFERRED TO AS, AND DOING BUSINESS AS:
NORTHSIDE TOOL RENTAL
PLEASE PRINT – ALL INFORMATION MUST BE COMPLETED
CREDIT CARD AUTHORIZATION PROCEDURE
CONTRACTORS:
THIS IS A MULTI-USE FORM. DEPENDING ON WHAT STATUS YOU WOULD LIKE TO HAVE WITH NORTHSIDE TOOL RENTAL WILL DEPEND
ON HOW MUCH OF THIS APPLICATION YOU COMPLETE.
CONTRACTOR DISCOUNT ONLY:
FOR CONTRACTORS WHO ONLY ARE INTERESTED ONLY IN THE CONTRACTOR DISCOUNT FOR YOURSELF, PLEASE COMPLETE THE FIRST
SECTION:
PERSONAL & COMPANY INFORMATION AND SIGN AT THE BOTTOM.
YOU MAY EITHER GIVE THE APPLICATION TO A STORE REPRESENTATIVE, OR FAX IT TO THE CORPORATE OFFICE AT 404-237-8993.
CONTRACTORS DISCOUNT AND CREDIT CARD ON FILE:
FOR CONTRACTORS INTERESTED IN HAVING THEIR CREDIT CARD ON FILE IN ORDER TO ALLOW THEIR EMPLOYEES TO RENT, SIGN FOR,
OR PICK UP EQUIPMENT FOR YOU, PLEASE COMPLETE THE ENTIRE APPLICATION AND SIGN AS INDICATED.
THE APPLICATION MAY BE FAXED TO OUR CORPORATE OFFICE OR GIVEN TO A STORE REPRESENTATIVE.
CONTRACTORS WHO WISH TO SET UP A CREDIT CARD ON FILE MUST PHYSICALLY APPEAR IN ONE OF NTR’S STORES WITH THE CREDIT
CARD MATCHING THE INFORMATION ON THE APPLICATION AND A GEORGIA DRIVER’S LICENSE WHERE BOTH NAMES MATCH ON THE
CREDIT CARD AND DRIVER’S LICENSE.
NORTHSIDE TOOL RENTAL REPRESENTATIVES:
IN ORDERTO CORRECTLY ENROLL A VIP CONTRACTOR IN THE CREDIT CARD ON FILE PROGRAM, PLEASE COMPLETE THE FOLLOWING:
1. REQUEST THE CUSTOMER’S DRIVERS LICENSE AND CREDIT CARD.
A. VERIFY THAT THE NAME MATCHES ON THE CREDIT CARD AND DRIVER’S LICENSE
B. VERIFY THAT THEY GAVE YOU A TRUE CREDIT CARD – WE DO NOT ACCEPT DEBIT CARDS FOR THIS PROGRAM AT THIS TIME.
C. VERIFY THAT YOU HAVE A GEORGIA DRIVERS LICENSE, NOT AN “ID ONLY” OR FROM ANOTHER STATE.
D. IF THE APPLICATION WAS PREVIOUSLY SENT TO THE OFFICE, PLEASE CALL TO VERIFY THAT YOU HAVE THE CORRECT CARD.
2. COPY THE DRIVERS LICENSE AND CREDIT CARD.
3. TAKE AN IMPRINT OF THE CREDIT CARD.
4. ATTACH THE IMPRINT TO THE COPIES.
5. SEND THE COPIES AND IMPRINT TO THE OFFICE.
OFFICE USE ONLY
STORE:
ACCT OPENED:
EMPLOYEE:
CUSTOMER #:
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