Legal Business Name*

Fed Tax ID#


Trade Name*

Type: Corporation; LLC; Govt; Partnership;Other

State of Formation




Owner/Officer Name*



A/P Contact




Physical Address




Mailing Address




Trade (3) and Bank Credit References

A/C #


Fax or Email








Fax or Email

Purchase Order Numbers Required

Invoices and Statements Emailed

List of Authorized Purchasers / Signatories

Please provide tax exemption certificate if you are tax-exempt.

Has Applicant or any of its owners, partners, officers or directors ever been a debtor in a voluntary or an involuntary bankruptcy filing, had a receiver appointed, or made an assignment for the benefit of creditors?

By its signature below, Applicant acknowledges it has read and understands Atlantic Lift Systems, Inc. (“ALS”) terms and conditions below and on the reverse side or page 2 of this credit pplication, on ALS’s website, and printed on the back of its rental contracts, and agrees to be bound thereby. Applicant hereby applies to ALS for credit and specifically consents to ALS investigating pplicant's credit history and authorizes its vendors and banks above to release Applicant’s financial and ayment information to ALS.

Applicant Signature


Printed Name*



Applicant’s Authorization & Agreement
Warranties, Covenants & Conditions:

The undersigned (“Applicant”), in consideration of Atlantic Lift Systems, Inc., (“ALS”) extending commercial credit based upon the information furnished herein, agrees that by executing this Agreement (a) all Applicant’s purchases and rentals are subject to the terms and conditions contained herein; (b) Applicant has reviewed and accepts the terms and conditions of ALS’s Rental Contract, which are on the reverse side of each and every Rental Contract; (c) such terms and conditions are deemed incorporated into and made a part of this Agreement and each and every rental of equipment and/or sale or provision of goods or labor furnished to Applicant, whether or not Applicant executes each such Contract; and (d) any terms and conditions appearing in an Applicant’s purchase order (PO) that are inconsistent with or in addition to the terms and conditions of this Agreement shall be void and of no effect. If a PO number is required, it is the responsibility of the Applicant to supply this number before or at the time of purchase or rental.

In making this Agreement, Applicant understands and agrees to ALS’s terms of payment as follows: Payment is due in full within 30 days of contract date (net 30), and all unpaid balances will incur service charges of 1.5% per month (18% per annum). Any disputed invoices must be brought to the attention of ALS IN WRITING within forty-five (45) days of receipt OR the Applicant shall be deemed to have expressly waived any such dispute.

At ALS’s discretion, any account with a delinquent balance may be placed on a cash basis, deposits may be required and the rental equipment picked up without notice. In the event that Applicant’s account with ALS becomes delinquent and past due, and ALS engages the services of an attorney to collect the account, then, subject to the applicable law, Applicant, and any person jointly and severally liable with Applicant, agrees to reimburse to ALS attorney’s fees in an
amount equal to 33-1/3% of the amount due, or such greater amount as the Court deems reasonable, whether or not litigation is commenced, and court costs expended. Applicant agrees that jurisdiction for all such actions or suits for breach of these Warranties, Covenants & Conditions or for Applicant’s breach or failure to make timely payment may at ALS’s discretion be instituted or maintained in Fairfax County, Virginia.

Damage waiver is charged on all rentals unless a valid certificate of insurance is submitted to Atlantic Lift Systems, Inc., prior to the rental.

Applicant agrees it may conduct this Agreement with ALS electronically and that an electronic signature or any indication of agreement and consent (eg, an “I Agree” button or typing a name in a “signature” box on any notice or other communication required or permitted to be given hereunder, or pursuant or relating to any Agreement), shall have the same force and effect as the use of manual signatures. In any dispute hereunder, related to the Agreement, or related to Applicant’s use of ALS’s website, Applicant agrees it will have the burden of proving (i) any electronic manifestation of assent received by ALS is not attributable to Applicant; and (ii) Applicant did not have an opportunity to review any electronic terms and conditions posted on ALS’s website.

The individual executing this Agreement warrants that they are authorized to do so and the information contained in this Agreement is a true and correct statement of the financial condition of Applicant. The Applicant agrees to advise ALS in writing of any material change in any information set forth herein or furnished herewith. If any part of this Agreement is held unenforceable, the remainder of this Agreement shall not be affected thereby. I guarantee payment
of this account.

Atlantic Lift Systems, Inc. | Richmond & Norfolk, VA
(844) 70-RENTS (73687) (O) | (757) 461-8337(F)