3435 E Elwood St · Phoenix · AZ · 85040
480-557-Todd (8633) · 480-557-6380 (Fax) · 800-524-5535 (Toll Free)
APPLICATION WWW.TOWTRX.COM
COMPANY :			TIN :
ADDRESS :			CITY/STATE :
ZIP :			BUSINESS PHONE :
BUSINESS FAX :			EMAIL :
TYPE OF BUSINESS :			YEARS IN BUSINESS :
Have the applicants filed for bankruptcy in a personal or business capacity? :				Yes No
If yes, when :
PERSONAL INFORMATION ON OFFICERS, PARTNERS OR GUARANTORS
NAME :			TITLE :
SSN :			OWNERSHIP :
HOME ADDRESS :			CITY/STATE :
ZIP :
BANK REFERENCES
NAME OF BANK :			NUMBER :
PHONE :			CONTACT :
TRADE REFERENCES
NAME OF SUPPLIER : PHONE : CONTACT :
DECLARATION: The undersigned agrees that the information provided above is true and correct. The undersigned authorizes Todd Equipment to submit this application to our financial partners and obtain the credit history of the undersigned and the officers and principals of the Company and to investigate such credit history from any source.
SIGNATURE : TITLE : DATE :
EQUIPMENT DESCRIPTION : EQUIPMENT COST :
PLEASE RETURN COMPLETED APPLICATION TO 480-557-6380