R.A. Greig Equipment Company

2974 West 17 Street   ·  Erie, PA  16505

(814) 838-3528  ·  Fax (814) 838-1788

Toll Free  (800) 444-2507

 

Credit Application

 

Business Name:

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Phone:

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Address:

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Mailing Address:

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Names of Owners

 

 

 

 

 

 

 

Name:

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Name:

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Address:

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Address:

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Date Business Started:

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How long at current location:

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Listed in Dunn & Bradstreet:

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How listed:

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Insurance Co:

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Phone:

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Agent:

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Fax:

____________________

 

 

 

 

Please list three (3) credit references and one (1) bank reference.  Include complete address, phone, fax and account number if possible.

 

Name:

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Name:

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Address:

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Address:

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_________________________

 

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Phone:

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Phone:

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Fax:

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Fax:

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Account No:

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Account No:

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Name:

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Bank Name:

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Address:

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Address:

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Phone:

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Phone:

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Fax:

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Fax:

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Account No:

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Account No:

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Have you purchased from us before:

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If so, under what name:

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Owners signature:

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Date:

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R.A. Greig

Equipment Company

(814) 838-9528  ·  Fax (814) 838-1788

2974 West 17 Street

Erie, PA  16505

 

ATTN:  PLEASE FORWARD TO YOUR COMPANY’S INSURANCE AGENT

 

Insurance Requirements For:

 

All customers must have on file prior to any rental a certificate of insurance meeting the following requirements:

 

R.A. Greig Equipment Company as ADDITIONAL INSURED LOSS PAYEE and CERIFIICATE HOLDER

 

Certificate must state the following PROOF OF INSURANCE

 

WORKMANS COMPENSATION

LIABILITY INSURANCE for a minimum amount of one (1) million dollars

CONTRACTORS EQUIPMENT coverage or equal insurance

PROPERTY DAMAGE for a minimum of five hundred thousand dollars ($500,000.00)

 

Keeping a valid certificate of insurance will expedite all your rental orders in a timely fashion.  If your company changes carriers or if any changes are made in your policy please notify Greig Equipment and Burns and Burns Insurance

 

 

Type of Equipment:

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Model:

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Value:

_____________________________________________

 

PLEASE FAX CERTIFICATE TO BURNS AND BURNS INSURANCE  (814) 836-0404 AS SOON AS POSSIBLE AND AT EACH POLICY CHANGE OR RENEWAL AND A COPY TO R.A. Greig EQUIPMENT COMPANY    (814) 838-1788

 

Sincerely,

R.A. GREIG EQUIPMENT COMPANY, INC.

Robin Matthews