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INDIVIDUALS

 COMPANIES 





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INDIVIDUALS

 COMPANIES 

New Customer Form - INDIVIDUALS

All new customers must establish an account with us prior to renting any equipment. We have streamlined the process with this updated online form. Please contact us if you have any questions. We look forward to your business.

*Required Fields

PART 1: Contact Information

If you already registered, LOG IN HERE to auto-fill this section!


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Billing Address


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REPLACEMENT VALUE of equipment being rented





PART 2: OPTIONAL Information

The following information is optional but can increase the limits on your account. This information is NOT STORED in our database and will only be used to verify your account.

Current Employer

Your Position


Years at this Job

Employer Phone


Driver's License Number

State


Date of Birth

Social Security, Last 4 digits




Professional References

All applicants must provide references for a Cash And Carry account. A professional reference is a company or person who you do business with, preferably one in which you have established credit or someone you have worked with in the industry.

Reference 1

Full Name

Company Affiliation


Address


City, State, Zip


Company Phone

Mobile Phone

Email Address



Reference 2

Full Name

Company Affiliation


Address


City, State, Zip


Company Phone

Mobile Phone

Email Address



All information entered on this form is warranted to be true and is for the purpose of establishing an account at Budget Video Rentals. I authorize Budget Video Rentals to contact my references and verify the information in all fields.

Digital Signature* (what's this?)


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