Rental Customer Account Information Submission

Please use the following form to submit information about your rental customers. Please complete submission form by filling in all relevant form fields. Be assured that the information you submit is kept secure and confidential.

*Required


Customer Information

*Customer Name:

*Address, City & State:

*Zip:

Physical Address, City & State (if different):

Zip:

*Type of Business:

*Year Started::

*Product or Service Provided:

*USDOT#:

*Federal ID#:

Business Information

*Business Owner Name:

*Business Classification:

*Business Website:

Corporate Address, City & State (if different from local address):

Zip:


Primary Contact

*Contact Name:

*Office Phone:

*Cell Phone:

*Email:

*Preferred Method of Contact:

Secondary Contact

*Contact Name:

*Office Phone:

*Cell Phone:

*Email:

*Preferred Method of Contact:


Vehicle Information

*Type of Vehicles Renting:
8 Passenger Minivan10 Passenger Transit Van12 Passenger Transit VanCargo Van 3/4 TonPickup ½ Ton Truck12 Ft Cube Truck15 Ft Cube Truck16 Ft Cube Truck16 Ft Box Truck24 Ft Box Truck16 Ft Stake Truck24 Ft Stake TruckTandem Axle Tractor

*Projected Frequency:

*Does customer own their own trucks?
YesNo

If yes, what type of units:

*Does customer provide company take home vehicles?
YesNo

*Any chance for service maintenance work?
YesNo

*Potential for lease or sale of units?
YesNo

*How did you acquire this customer?
Cold CallReferralRental HistoryReservation CenterCall-InOther

If other, please explain:

*If existing customer, what year did they start doing business with us?

*Requested rate plan for this customer?


Sales Representative Information

*First Name:

*Email:

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