Five Star Logo FIVE STAR EQUIPMENT, INC. Home
P.O. Box 176, Dunham Drive, Dunmore, PA 18512
(570) 346-1701  Fax: (570) 346-3870
  APPLICATION TYPE
Sole Proprietorship Partnership Corporation State Of __ Subsidiary 
Division Individual Equipment Owned

Corporation Tax ID Number, if applicable: 
State, if applicable: 
  COMPANY INFORMATION
Company Name:  
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Accounts Payable Address (if different):  
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No. Years in Business Under This Name:  
No. Years at This Location:  
Credit Line Requested $  
P.O.'s Required   Yes
No
Payment  Personally Guaranteed?   Yes
No
By:  
Title:  
 OWNERSHIP
Name of Owner:  Social Security #: 
Home Address:  City: 
Phone #:  State:  Zip Code: 
Name of Owner:  Social Security #: 
Home Address:  City: 
Phone #:  State:  Zip Code: 
Name of Owner:  Social Security #: 
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 TRADE REFERENCE
Company Name: 
Address:  City: 
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Company Name: 
Address:  City: 
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Company Name: 
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 BANK REFERENCE
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Home Address:  City: 
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Bank Name: 
Home Address:  City: 
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  COMMENTS
In consideration of Five Star Equipment, Inc. extending credit to me...we agree to the following terms:

  1. Terms of Sale are not 30 days from date of invoice on all parts and service...
  2. Equipment rentals require first months rent in advance.
  3. To PAY ALL REASONABLE ATTORNEY FEES for the collection and enforcement of all delinquent and unpaid accounts.
  4. In the event payment is not received in full 45 days following purchase to PAY A FINANCE CHARGE at the rate of 1½% per month which is an annual rate of 18% on all unpaid invoices over 45 days past due.
All Statements made herein are true and accurate to the best of our knowledge. We authorize the above company to make any and all inquiries necessary for action on this credit application. We hereby indemnify the above company and its agents, from any liability resulting from their credit survey.

Name*:      Date*: 
 
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