ACCOUNT FACILITY APPLICATION

BUSINESS NAME*   REGISTERED NAME*

ACN/ABN*

BUSINESS REGISTERED STATUS* Private companyPublic companyTrustSole traderPartnership#
#Partnership NB: If Partnership, please provide applicant details of each Partner below

Date of incorporation or when business established (dd/mm/yyyy)*

Specify Business Monthly Sales*   Specify Business Monthly Expenses*

If new ownership, please provide details of previous businesses figures and your forecast estimates. An additional 20% deposit may be requested for businesses with no history submitted

Business Phone*   Mobile*   Fax

Email*

Billing Address*   State* ---VICNSWACTQLDTASSAWANT   Postcode*

Business Address*   State* ---VICNSWACTQLDTASSAWANT   Postcode*

Delivery Address (if different to business address)

Will you be organising insurance coverage for the equipment?* YesNo
A copy of the current Insurance Certificate covering the equipment will be required to be emailed to us.
If no, a Damage Waiver Fee of 12% of the Rental Cost is payable.

Applicant 1

First Name*   Surname*

Home Address*   State* ---VICNSWACTQLDTASSAWANT   Postcode*

Home Phone*   Drivers Licence No.*   Date of Birth (dd/mm/yyyy)*
(A copy of your driver’s licence(s) will be required)

Applicant 2

First Name   Surname

Home Address   State ---VICNSWACTQLDTASSAWANT   Postcode

Home Phone   Drivers Licence No.   Date of Birth (dd/mm/yyyy)
(A copy of your driver’s licence(s) will be required)

Trade References

Business Name 1*   Address*   Phone*

Business Name 2*   Address*   Phone*

If zero, please type '0' at each item below

The Applicant acknowledges reading the Privacy Policy provided on the web site (www.ezyrentalequipment.com.au/privacy-policy) and authorises Ezy Rental to make any enquiries relating to the persons herein named or otherwise.

The Applicant represents and warrants to EZY Rental that the above information is true and correct. As customer and Renter we accept and agree to the Terms and Conditions (Terms) provided on the web site (www.ezyrentalequipment.com.au/terms-conditions) and acknowledge reading the Terms before submitting this application. We agree the Terms may be varied with written notice. We acknowledge that our account is approved subject to these representations and warranties and at the discretion of EZY Rental and may be withdrawn at any time.

Acceptance by Applicant or authorised director/person/proprietor

I hereby declare that the above information is true and correct.

Please enter the characters shown before submitting