Customer Profile

Please fill out this profile if you are a customer of Idealease of Chattanooga

Thank you for wanting to partner with Idealease of Chattanooga. To help us better serve you please complete the form below if you are a new customer. Once your profile has been received you'll be contacted by an Idealease of Chattanooga Team Member.

Contact Us

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Required fields indicated with *

Company Name*

Physical Address

Address 1*

Address 2*

City*

State*

Zip*

Country*

Mailing Address

Mailing Address 1

Mailing Address 2

Mailing City

Mailing State

Mailing Zip

Mailing Country

Phone*

Principal and/or Officer

Principal and/or Officer 1 First Name*

Principal and/or Officer 1 Last Name*

Principal and/or Officer 2 First Name

Principal and/or Officer 2 Last Name

Has the business or its principals filed for bankruptcy in the past 7 years *

Type of business

Federal ID # *

Date business started *

Description of business (include Types of Commodities Hauled) *

Do you have and MC number? *

If yes, What is it?

Does your company require a unit number? *

Account Information

Is the company sales tax exempt? *

Does your company require a PO number? *

Accounting contact name

First Name*

Last Name*

Accounting contact email *

Accounting contact phone number *

Trade information

Reference 1 First Name *

Reference 1 Last Name *

Reference 1 Phone Number *

Reference 2 First Name *

Reference 2 Last Name *

Reference 2 Phone Number *

Reference 3 First Name *

Reference 3 Last Name *

Reference 3 Phone Number *

Banking Information

Name of Bank 1 *

Frist Name of Contact at Bank 1 *

Last Name of Contact at Bank 1 *

Phone of Bank 1 *

Name of Bank 2 *

Frist Name of Contact at Bank 2 *

Last Name of Contact at Bank 2 *

Phone of Bank 2 *

Name of Bank 3 *

Frist Name of Contact at Bank 3 *

Last Name of Contact at Bank 3 *

Phone of Bank 3 *

Insurance information

Name of insurance company *

Contact at Insurance Company First Name *

Contact at Insurance Company Last Name *

Phone Number of Insurance Company *

Email of Insurance Company *

Credit Check

Authorization to run company credit check *

Would you like us to run your company credit to complete the Customer set up process * By checking yes, you are stating I authorize Lesco to check my credit and other information supplied on this application and/or obtain information about credit experience with me and validate my insurability. “The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against applicants on the basis of sex or marital status. The Federal Agency which administers compliance with this law concerning Lesco, Inc. is the Federal Trade Commission, 730 Peachtree Street, NE, Atlanta, GA 30308.”

Terms and condition

If you intend on using Lesco’s insurance carrier, you must meet their eligibility requirements. Please attach a current Motor Vehicle Report for each driver or list each driver’s full name, birth date, state of license and license number, social security number, number of years of commercial driving experience, and number of accidents and violations during the past three years. Additionally list the commodities that you will haul. I hereby authorize any person or organization whose name I have given as character or credit reference, to furnish Lesco, Inc. any information they may have concerning me, whether on record or not and I hereby release all such persons and organizations from any claims for damages or otherwise by reason of furnishing such information and records. I authorize Lesco to check my credit and other information supplied on this application and/or obtain information about credit experience with me and validate my insurability. “The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against applicants on the basis of sex or marital status. The Federal Agency which administers compliance with this law concerning Lesco, Inc. is the Federal Trade Commission, 730 Peachtree Street, NE, Atlanta, GA 30308.” Terms are Net 30 days. Invoice amounts not paid timely will be subject to a late charge of 1.5% per month, 18% per annum. Lesco has the sole authority to extend or modify these terms. I understand, accept and hereby consent to these terms. Additionally I agree to pay collection costs and reasonable attorney fees if I fail to pay within these terms.

Terms *

First Name of Person Completing Form *

Last Name of Person Completing Form *

Title of Person Completing Form *

Date*

To prove you are a human, please tell us which one you can ride?

CUSTOMER PROFILE