Customer Information

*Customer Name:

*Address, City & State:

*Zip:

Physical Address, City & State (if different):

Zip:

*Type of Business:

*Year Started::

*Product or Service Provided:

*USDOT#:

*Federal ID#:

Business Information

*Business Owner Name:

*Business Classification:
---Local BusinessCorporation

*Business Website:

Corporate Address, City & State (if different from local address):

Zip:

Primary Contact

*Contact Name:

*Office Phone:

*Cell Phone:

*Email:

*Preferred Method of Contact:
---Office PhoneCell PhoneEmailText Message

Secondary Contact

*Contact Name:

*Office Phone:

*Cell Phone:

*Email:

*Preferred Method of Contact:
---Office PhoneCell PhoneEmailText Message

Vehicle Information

*Type of Vehicles Renting:
12 Passenger Transit VanCargo Van 3/4 Ton24 Ft Box TruckDump Truck24 Ft Stake TruckTandem Axle TractorTandem Axle Tractor with Sleeper

*Projected Frequency:
---DailyWeeklyBi-WeeklyMonthlyBi-Monthly

*Does customer own their own trucks?
YesNo

If yes, what type of units:

*Does customer provide company take home vehicles?
YesNo

*Any chance for service maintenance work?
YesNo

*Potential for lease or sale of units?
YesNo

*How did you acquire this customer?
Cold CallReferralRental HistoryReservation CenterCall-InOther

If other, please explain:

*If existing customer, what year did they start doing business with us?

*Requested rate plan for this customer?

Sales Representative Information

*First Name:

*Email: