Tag Test Page | Utility Keystone Semi-Trailer Sales

Company Information

What are you applying for?*
- Semi-Trailer Purchase
- (PennStro Leasing) Semi-Trailer Lease/Rent
- Parts Credit
Hidden
What are you applying for?
Who is Your Sales Representative?*
Leasing or Renting?*
Which Branch Location Would Your Prefer to Lease or Rent From?*
Describe Your Lease and/or Rental Equipment Needs*
Name*
First Name M. I. Last Name
Title
Amount Requested:
Office Phone Number*
Cell Phone Number*
Fax Number
Email Address*
Company Name*
Type of Business
Company Website
Physical Address*
Physical Address Street Physical Address City State ZIP / Postal Code
Mailing Address*
Same as Physical Address?

Mailing Address Street Mailing Address City State ZIP / Postal Code
Shop Contact
Shop Phone Number
Shop Email Address
Parts Contact
Parts Phone Number
Parts Email Address
Is a PO# required
- Yes
- No
Tax Exempt
- Yes
- No
Tax Exempt #

If exempt, please attach copy of exemption certificate.
Exemption Certificate
Accepted file types: pdf, jpg, png, gif, doc, docx, Max. file size: 1 GB.
Federal ID #*
Date Operation Began*
MM slash DD slash YYYY
Number of Employees
US DOT Number*
MC Number*
Principal Owner
Principal Owner Email Address
Accts Payable Contact
Accounts Payable Email Address

Banking Information

Please provide three (3) similar trade/vendor references

1)

2)

3)

Personal Guarantor Information

If you are applying for trailer purchase credit complete the information below. If not, skip to INSURANCE INFORMATION.
Who is the sales representative you are working with?
Full Name*
Percent Ownership:*
Number of Power Units Owned*
Social Security Number*
Cell Phone*
Home Phone*
Mailing Address*
Mailing Address Street Mailing Address City State ZIP / Postal Code
How long have you lived at your current residence?
Do you rent or own?
One Million Dollars in Annual Revenue?*
- Yes
- No
Date of Birth*
MM slash DD slash YYYY

Insurance Information

If yes, complete the information below and see our standard terms and conditions. If no, skip to AGREEMENT.
Do you transport hazardous material(s)?
- Yes
- No
If yes, what material(s)?
Risk Management Insurance Provider*
Contact*
Phone*
Email Address*
Is your Liability Insurance the same as above?
- Yes
- No
Liability Insurance Provider
Contact
Phone
Email Address
Is your Physical Damage Coverage Option the same as above?
- Yes
- No
Physical Damage Coverage Provider
Contact
Phone
Email Address

Thank you for your interest in leasing and renting with PennStro Leasing, LLC – a sister company to Utility Keystone Trailer Sales, Inc. Please take a moment to read, then sign our Standard Terms and Conditions before moving forward.
Signature - Standard Terms & Conditions*
Consent*
I have read and understand the Standard Terms & Conditions*

Agreement

Permission is hereby granted to Utility Keystone Trailer Sales, Inc., PennStro Leasing, LLC, and any financial institutions recommended for equipment financing to obtain any credit information necessary to establish this account. It is understood and agreed that terms are 21 DAYS from date of invoice and any fees incurred from outside sources to collect money owed will be the responsibility of the customer to pay. By signing below, (1) I represent and warrant that I am authorized to agree to the STANDARD TERMS AND CONDITIONS set forth on behalf of the applicant, (2) I am the individual identified, and (3) I understand that I am agreeing to the STANDARD TERMS AND CONDITIONS on behalf of the applicant.
Signature
Date
MM slash DD slash YYYY

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Tag Test