enterprise GOVERNMENT CREDIT APPLICATION
FLEET MANAGEMENT
Please complete all applicable items.
Company Name Credit Applicant _ Year Business Started
Street Address City State Zip.
E-mail Phone #_ _ Fax #
Government Entity Type: • State •county •City Dother:
Type of Business Duns Number.
Parent Company or Affiliates(Name & Address):
PRIMARY CONTACT INFORMATION
Name E-mail Phone #
Fleet Manager Address
FINANCIAL INFORMATION
Are your books prepared by an outside Accountant? • Yes •No Accountant Name Email Address Phone#
ENCLOSING WITH APPLICATION
Three years of Financial Statements (with footnotes) •Audited • Opinioned • Internal Published Annual Reports •Yes •No
Income Tax Returns (3 years) •Yes •No
Other Items Included:
Federal ID Number:
Fiscal Year End (Month):
CURRENT VEHICLE SUPPLIER
Principle Suppliers Phone # E-Mail Address Acct # # of Vehicles Current Vehicle Suppliers Phone # E-Mail Address Acci # #of Vehicles •Purchasing • Leasing •Finance
INSURANCE
Company Agent Policy # Exp. Date
Street Address _ City. State Zip
Phone # Fax #
ACH AUTHORIZATION AGREEMENT
LESSEE INFORMATIONI
Company Name FEIN
Street Address City. State _Zip.
Contact Name Phone # _ Fax #
Email Address
BANK INFORMATIONI
Bank Name Checking Account Only
Street Address City. State _Zip-
Bank Contact Name Phone # Fax #
ABA / Routing Number: Account Number:
**PLEASE ATTACH A VOIDED CHECK FOR THE ACCOUNT LISTED ABOVE** Upon approval of this Credit Application, I (we) hereby authorize Enterprise Fleet Management, Inc., hereinafter called "EFM", to initiate, if necessary, credit entries and adjustments for any debit entries in error, to my/our checking account indicated above and to further authorize the depositorv named above hereinafter called "DEPOSITORY", to debit and/or credit the same to such account. I (we) covenant and agree to instruct any and all banks or other financia institution specified in this Credit Application and ACH authorization to process debits using the Automated Clearing House funds-transfer system.
This transaction will be completed in accordance with the following provisions:
1. The withdrawal will occur on the 20th of each month. If the 20th of each month falls on a weekend, amounts will be withdrawn on the next business day.
2. An electronic copy of the invoice and/or statement will be available on EM's website (http://efmfleetaccess.efleets.com) by the 5th business day of each month. The Lessee will be expected to review the invoice/statement prior to the 15th of each month. The Lessee reserves the right to call EFM and dispute a charge by the 15th of the month. EFM will withdraw the entire invoice amount each month if no charges have been disputed by the 15th of each month. Upon request to EFM, a hard copy of an invoice or statement will be mailed to the lessee each month via the United States Postal Service.
3. For any amount owed by the Lessee to EFM that is not paid due to insufficient funds on the date the debit should occur, a $25 non-suffi- cient funds transaction fee will be assessed. The transaction fee shall be paid by the Lessee to EFM on demand.
4. This authorization is to remain in full force and effect until EFM has received written notification from the Lessee of its termination in such time and in such manner as to afford EFM and DEPOSITORY a reasonable opportunity to act on it. Cancellation will also occur if EFM has sent the Lessee a ten day written notice for EFM's termination of the agreement. Cancellation requests for this agreement should be forwarded to:
STATEMENT OF POLICY AND PROCEDURES I
Enterprise Fleet Management, Inc. and affiliates will use the information provided in this for the purpose of fleet and rental related services/programs.
Enterprise Fleet Management, Inc. reserves the right to return this application if all sections are not completed or determined misleading.
Enterprise Fleet Management, Inc. will conduct future inquiries on an annual basis as part of the annual credit review process or as fleet size increases, and reserves the right to ask for additional or updated financial information as the need warrants as part of the credit underwriting process.
AUTHORIZED SIGNERS FOR MOTOR VEHICLE LEASE(S)
RESOLVED, The undersigned hereby certifies (i) that he/she is the duly appointed - (Title) for (Entity legal name) hereafter known as "The Entity", (i) that he/she is authorized by The Entity to execute and deliver on behalf of The Entity to Enterprise Fleet Management, hereafter known as "Enterprise" ("Lessor") and the Master Lease Agreement between Enterprise and the Entity ) the ("Lessee"), and (il) that the following individuals are authorized and empowered on behalf of and in the name of The Entity to execute and deliver to Enterprise Schedules to the Lease for individual motor vehicles, together with any other necessary documents in connection with those Schedules:
RESOLVED FURTHER, that:
Print Name Title
Print Name Title
Print Name Title
Print Name Title
Print Name Title
Print Name Title
Bond Rating: Rating Agency: _ _ Federal ID#:
RESOLVED FURTHER, that EFM is authorized to act upon this authorization until written notice of its revocation is received by EFM.
I do herby certify that the information contained in this Credit Application is accurate in all material aspects as required by law. Further, I do hereby certify Print Name Title
Signature Company Name
Date
For the purpose of seeking lo secure credit from Enterprise Fleet Management, Inc. (together with its affiliates, successors, assigns and third party service providers, "EM"), Credit Applican! (a) authorizes (i) EFM to run a credit report, investigate and verify the information in this Credit Agreement, and/or obtain financial and/or credi! information from any person or entity with which Credit Applicant has or had financial dealings, including banks, lending institutions and trade or credit references, whether or not such person or entity is icentified in this Credit Application, which information may include financial statements, tax returns, and banking records, (i) EM to contact any of Credit Applicant's current or former employers or creditors to verify any information contained herein or received in connection with this Credit Application if Credit Applicant is a sole proprietor, and (iii) any third party who may have relevant information to provide such information to EFM, (b) will notify EFM if there is any change in name, address, or any material adverse change (i) in any of the information contained in this Credit Application, (it) in Credit Applicant's financial condition, or (ili) in Credit Applicant's ability to perform their respective obligations to EFM, and (c) represents and warrants that any and all information provided to EFM by Credit Applicant is true, correct and complete as of the date hereof. The lack of any notice of change in the representations and warranties included in this Credit Application shall be considered a continuing statement that the information provided in this Credit Application remains true, correct and complete.
As permitted by law, EFM may also release information about EM's credit experience with Credit Applicant. Credit Applicant understands and agrees that all reports and records developed by EFM or any third party agent in connection with the foregoing investigations are the sole property of EFM and will not be provided to Credit Applicant unless otherwise required by applicable law or agreed to by EFM in writing.
The Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided that Credit Applicant has the capacity to enter into a binding contract); because all or part of Credit Applicant's income derives from any public assistance program; or because Credit Applicant has in good faith exercised any right under the Consumer Credit Protection Act. If this credit application is denied, Credit Applicant may have the right to a written statement of the specific reason(s) for the denial. To request to obtain the statement, Credit Applicant may contact EFM at: 600 Corporate Park Drive, ATT: EFM Credit Department, St. Louis, MO 63105, within 60 days from the date Credit Appiicant is notified of the denial. If applicable, within 30 days of EFM's receipt of the request, EFM will send Credit Applicant a written statement specifying the reason(s) for the denial.
The person signing below personally represents and warrants to EFM that he/she is authorized to make this application for credit on behalf of Credit Applicant.
Please note that this Credit Application is an appiication and does not commit or require EFM to extend any credit whatsoever to Credit Applicant. © 2018 Enterprise Flect Management, Inc. H00479_EFM Government Credit Application