company charge
account application
1213 NP Ave P.O. Box 333 • Fargo, ND 58102 • (701) 232-8971
112 N 4th St • Bismarck, ND 58502 • (701) 258-5060
1038 N Minnesota Ave • Sioux Falls, SD 57104 • (605) 336-2437
Company___________________________________________________________________________________________________
Street Address_________________________________________ PO Box______________________________________________
City, State, Zip_______________________________________________________________________________________________ Telephone ____________________________________________ Fax__________________________________________________
Email_________________________________________________ Website______________________________________________
Accounts Payable Contact Person_______________________________________________________________________________
When complete return to: m Fargo location m Bismarck Location m Sioux Falls Location
How long in: m Business _______
m Corporation _______ m Partnership _______ m Single Proprietorship _______
If single Prop. SSN#________________
Sales Tax Exempt m No m Yes (If yes, send tax-exempt certificate)
Federal ID#_______________________
Credit Limit Requested_ ________________________________
Nature of Business
___________________________________________________________________________________________________________
List of Partners or Officers:
Name
Street Address
City
State
Zip
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
Credit References: (Please list three and complete all information)
(1)
(2)
(3)
Name
_____________________________
_____________________________
_____________________________
Street Address
_____________________________
_____________________________ _____________________________ City, State, Zip
_____________________________
_____________________________ _____________________________
Account #
_____________________________
_____________________________
_____________________________
Telephone #
_____________________________
_____________________________
_____________________________
Fax #
_____________________________
_____________________________
_____________________________
Your Bank:
Name
Street Address
City
State
Zip
_______________________________________________________________________________________________________________
Loan Officer:__________________________________________________________________________________________________
Note:
The undersigned official, to induce the granting of credit to the above named firm, hereby personally guarantees the company’s credit. Be it understood that all
purchased be due and payable 30 days from date of purchase. With my signature below, I hereby authorize the above credit and bank references to release
my credit information the The Mathison Company.
Date:_________________________________________________ Signed by:___________________________________________
Individually and as an Officer of the Firm
LIABILITY: Lessee covenants and agrees to keep the Lessor harmless and free from any and all cost, expense, claims and liability
arising out of the use, operation, handling, maintenance and/or delivery of said equipment, and further covenants and agrees to
pay Lessor in full for any and all damages caused to, or suffered by, said equipment regardless of cause, ordinary wear and tear
excepted, from time of departure from Lessor’s premises to time of return to Lessor’s premises. Lessee expressly agree that Lessor’s
statement of charges in connection with any loss or damage cause to or suffered by said equipment while in Lessee’s possession
shall be accepted as correct by Lessee and be paid by lessee forthwith. In case of loss or destruction of said rental equipment, or
loss of possession thereof, on inability to return same to Lessor, the Lessee agrees to pay Lessor the complete and full replacement
value of said equipment as stipulated hereon.
WAIVER OF DEFECTS: Lessee acknowledges said equipment to be in a good, safe and serviceable condition and fit for its
intended uses.
LESSOR NOT RESPONSIBLE: Lessor is not responsible for damage regardless of cause to Lessee’s property arising out of use
of Lessor’s equipment including water damage, collision, transportation damages and other miscellaneous causes.
CONDITIONS UNDER WHICH EQUIPMENT IS RENTED
RENTALS ARE CASH IN ADVANCE
All equipment is used at Lessee’s risk. We exercise precaution in keeping our equipment in good condition. Conditions which
prevent satisfactory operation of equipment do not relieve Lessee of his responsibility for rental charges.
Lessee assumes all responsibility for equipment while out of possession of Lessor and promises to return such equipment to the Lessor in as good condition as it was at the effective date of the rental, natural wear from a responsible use excepted. Lessee shall be
liable for any loss, theft, damage or destruction of leased property.
It is agreed that this personal property is leased to me or us by the rental service shown on the face of contract and will be used
by the Lessee at the designated address of the stated period and solely for the purpose of which said equipment was manufactured
and intended.
It is further agreed that this equipment will not be removed from the address heron listed for use at any other address without
consent of the Lessor.
Scheduled rental rates begin when equipment leaves our premises and continues until returned thereto. A cleaning charge will be
made on items returned unclean. No refund or adjustment will be due to weather condition or any other circumstances beyond our
control. A service charge of 1 ½ percent per month will apply to all accounts over 30 days old.
I agree that all charges for rental, damage, cleaning or material will be paid and that all collection fees, attorney fees, court costs,
or any expense involved in the collection of these charges will be borne by me in the court of the county in which indebtedness is
incurred.
LESSEE RISK: The following risks are assumed by the Lessee:
(a) Loss or damage by theft, vandalism or malicious mischief;
(b) Loss or damage of excess wear resulting from misuse, abuse, excess use, or Lessee’s improper servicing of equipment. In
determining abuse or excess wear or use of the property, any use or wear of the property which results in damage or change in
physical structure of the works or cabinetry of such property shall be considered excessive wear and use of the property. (Lessee
will not be responsible for reasonable wear, tear and use of the time);
(c) Loss due to any mysterious disappearance or due to wrongful conversion by a person entrusted with property or equipment;
(d) Loss or damage to equipment as the result of violation of any of the terms of this agreement.
Lessee will take reasonable precaution to protect the property and equipment at all times and will promptly submit a
written police report when Lessor requests same.
(e) Lessee will be responsible for damage due to fire, smoke, explosion, riot, windstorms, flood and earthquakes.
SUBLETTING AND LOCATION: No item of leased equipment shall be sublet or assigned, or removed from the location at which
Lessee represented it was intended to be used, or removed from the State of Lessor’s premises, except by written consent of Lessor.
LESSEE PURCHASE OPTION: The Lessor agrees that if the Lessee indicates, prior to the termination of the Lease, that he wishes
to purchase new equipment of the type lease, 100% of the first month’s rental fee will be applied to the purchase price. After the
first month, 70% of the rental fees will be applied to the purchase price until 80% of the total purchase price is reached.