Credit Application

How Can We Help?

Company Name
DBA (if different)
Contact Person
A/P Contact
Invoice
E-mailMail
Address
Phone
Fax
Mobile
Email Address
Federal Tax ID
Date Business Established
Amount of credit required $

Are you a:

CORPORATION
State Of Incorporation
Names, titles, and addresses of your three chief corporate officers
Name and address of your resident agent
PARTNERSHIP
Names and addresses of your partners
SOLE PROPRIETORSHIP
Are you sales tax exempt?
YesNo
Have you ever had credit with us before?
YesNo
If yes, under what name?
Authorized Purchasers
Purchase order required??
YesNo

TRADE REFERENCES

Reference 1
Name
Address
Phone
Reference 2
Name
Address
Phone
Reference 3
Name
Address
Phone

I represent that the above information is true and is given to induce to extend credit to the applicant. My company and I authorize to make such credit investigation as sees fit, including contacting the above trade references and banks and obtaining credit reports. My company and I authorize all trade references, banks, and credit reporting agencies to disclose to any and all information concerning the financial and credit history of my company and myself.

I have read the terms and conditions stated below and agree to all of these terms and conditions.
Authorized signature
Title
Date

GENERAL TERMS AND CONDITIONS AND PERSONAL GUARANTEE

  1. A service charge of 1.5% per month will be added to all amounts billed if not paid in 30 days.
  2. No additional credit will be extended to past due accounts unless satisfactory arrangements are made with our credit department. Customer is responsible for all and any responsible cost associated with collecting on accounts.
  3. Personal Guarantee:
    In consideration of Southeast Ready Mix extending credit to (Applicant), the undersigned personally (and if more than one, jointly and severally), unconditionally and irrevocably guarantees to Southeast Ready Mix the full and prompt payment when due, whether by agreement, acceleration, default, demand or otherwise, of all indebtedness of Applicant to Southeast Ready Mix including but not limited to Applicant's obligations in conjunction with invoices, or goods sold on credit. This is continuing and unlimited guarantee of payment and Southeast Ready Mix is not required to proceed against Applicant or to enforce any other remedy before proceeding against the undersigned to Southeast Ready Mix. It is understood that this guarantee shall benefit Southeast Ready Mix's successors and that it shall bind the undersigned's executors, beneficiaries, representatives or successors. The undersigned waives all notices and demands of any kind. All debts or obligations of the Applicant which are owed or may be owed to the undersigned in the future are subordinate to this guarantee and to the obligations and the indebtedness of the Applicant to Southeast Ready Mix. The undersigned authorizes Southeast Ready Mix to secure a credit report and agrees to the release of personal credit information to Southeast Ready Mix whether now or in the future, and a photocopy or facsimile shall be effective as an original for these purposes.
Authorized signature
Date