BusinessIQ

Getting Started

Sales Rep Name

Anticipated Credit Limit Requested
$

*If unable to complete online, then email printed copy to credit@atlaslift.com

Please Confirm The Atlas Company You Are Applying With

Company Information

^*Business Name

Doing Business As (DBA Name)

^*Tax ID

^*Billing Address

^*City

^*State/ Province

^*Zip/Postal

Country

Billing Address

City

State/ Province

Zip/Postal

Country

^*Accounts Payable Contact Name

^*Telephone

^*Email Address

Legal Structure

Type of Business

SIC Code

NAICS Code

Year Business Established

Business Website

^*Do You Require A Purchase Order?
Yes No

Parent Company Name (if Subsidiary)

Parent Company Address

Parent Company City, State, Zip

Parent Company President/Owner

Email address for e-invoices

Please list all additional locations that Atlas would be servicing and/or shipping direct

Address #1

Address #2

Address #3

Address #4

*Any further additional locations, please contact Atlas at credit@atlaslift.com

Trade Reference Information

Reference Name

Reference Type

Phone Number

Phone Number

Contact Email

Reference Name

Reference Type

Phone Number

Phone Number

Contact Email

Reference Name

Reference Type

Phone Number

Phone Number

Contact Email

Please Attach Trade Reference/Bank References Below

Bank Reference Information

Bank Name

Bank Account Number

Bank Contact Name

Bank Contact Phone Number

Bank Name

Bank Account Number

Bank Contact Name

Bank Contact Phone Number

Principal / Guarantor Information

Principal Type

Principal First Name

Principal Middle Name

Principal Last Name

Principal Home Address

City

State/ Province

Zip/Postal

Telephone - Home

Telephone - Work

Principal Email Address

Principal Social Security Number (SSN)

Attachments

If you are tax exempt you must provide a tax exempt certificate with the application.

Attachment Description

Attachment Location

Note: Accepted file formats include PDF, CSV, TXT and various image files (JPEG, JPG, GIF, BMP, TIFF, TIF, PNG, ICO). File attachments must not exceed 10 MB in combined size.

Terms and Conditions

^*Signature of Applicant

^*Title

^*Date

PRINT AGREEMENT

I agree to the terms and conditions specified above.

User Verification

Please complete the following by entering the value EXACTLY how it appears(case sensitive)

Why do I have to do this?