New Customer Application Form

New Customer Account Application Form

Thank you for your interest in becoming a Genie Customer! Please fill in the form below to begin the application process:

Bill To

LEGAL COMPANY NAME

BILL TO ADDRESS LINE 1:

BILL TO ADDRESS LINE 2:

BILL TO CITY:

BILL TO POSTAL CODE:

BILL TO PROVINCE:

BILL TO STATE:

BILL TO COUNTY:

BILL TO COUNTRY:

Ship To

Same as Bill To

Yes

LEGAL COMPANY NAME

BILL TO ADDRESS LINE 1:

BILL TO ADDRESS LINE 2:

SHIP TO CITY:

SHIP TO POSTAL CODE:

SHIP TO PROVINCE:

SHIP TO STATE:

SHIP TO COUNTY:

SHIP TO COUNTRY:

Previous step

Please acknowledge your agreement to the following by entering your name, date and title below:

I/we confirm that the information given in this application to open a credit account is in all respects true and accurate.
I/we also understand and agree that credit and background checks may be conducted for your business and its officers, directors, owners and partners.
I/we agree to allow Terex or its authorized agent to contact my bank for a reference and agree that Terex and its subsidiaries may use all information provided for credit, administration, marketing, and customer service purposes.
I/we agree that Terex or its authorized agent may contact credit reference agencies regarding my company, and may disclose information learned about my company to such agencies in order to make credit decisions related to my account.
I/we agree that all purchases from Terex and its subsidiaries will be subject to and governed by the Terex Terms and Conditions of Sale.

CERTIFIED BY (FULL NAME AND DATE):

POSITION:

Invoices are sent upon shipment. Orders must be paid in accordance to terms extended. Default terms are NET 30.
No additional credit will be extended to past due accounts unless satisfactory arrangements are made with our credit department.

If your purchase qualifies for sales tax exemption, please check this box and we will contact you for the required documentation.

Purchase applies for sales tax exemption

Please upload the requested documentation Below. Once you have uploaded the documents please submit the form to complete your application. Missing information may delay application processing and limit the acceptable payment terms.

A copy of your W-9 is required for all customers based in the U.S.

Upload Files

Add another

Please tell us how you will use the equipment:

Personal / Internal use

For resale

This is the final step in the application process. Please ensure that all information is correct and forms uploaded before proceeding to the next page.