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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!

First Name*

Last Name*

Email Address*

Mobile Phone*

Work Phone

Create a Password*

Verify Password*

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

Driver's License Number

State

Date of Birth

Social Security, Last 4 digits

Billing Address

Billing Name*

Address 1*

Address 2

City*

State / Province*

Country

Zip Code / Post Code*

REPLACEMENT VALUE of equipment being rented

PART 2: 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.

Current Employer

Your Position

Years at this Job

Employer Phone

Reference 1

Full Name

Company Affiliation

Address

City, State, Zip

Company Phone

Mobile Phone

Email Address

Reference 2