Update Account Information

Company Name *

Street Address *

City *

State *

Zip *

Business Phone *

Fax

Contact *

Contact Phone *

Email Address *

Authorized Purchasers / RentersPlease list persons authorized to rent and/or purchase equipment. (Applicant is responsible to periodically update list.)

First Name

Last Name

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First Name

Last Name

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First Name

Last Name

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First Name

Last Name

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Owner/Officer Signature *

Title *

Date *

Authorization *

**By entering my name on this form as my signature, I authorize the billing of all transactions incurred at Equip Rental and Sales, LLC to the credit card listed above. I agree to all terms and conditions set forth by Equip Rental and Sales, LLC, and understand that all sales are final. By signing this agreement, I relinquish the right to dispute the charge.**

A CERTIFICATE OF INSURANCE IS REQUIRED covering all rented equipment. Please list as follows: “Equip Rental and Sales, LLC. 420 S Church St, Saint Peters, Mo. 63376.” Equip Rental and Sales, LLC must be listed as "Loss Payee" and additional insured. Click HERE to view a COI form.

EQUIP RENTAL EQUIPMENT PROTECTION PACKAGE (EPP)-Equip Rental can provide physical damage waiver coverage. If this is chosen, an additional cost will apply. This will eliminate your need to supply a Certificate of Insurance. The cost will be noted on the rental contract. You have the option to accept or supply coverage. EPP Guide

To Submit:

Phone: 636-355-8080

Fax: 636-355-8081
Email: ar@equiprentalsales.com

Your Signature *