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Commercial Credit Application

 

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Company Information

Company Name: Address: Date:

City: State: Zip

Billing Address: City: State: Zip

A.P. Contact: Phone No.: Years in Business:

Amount of Credit Requested:

 

Ownership

Owner Name: Title.: Phone No.:

Home Address: City: State: Zip

 

Owner Name: Title.: Phone No.:

Home Address: City: State: Zip

 

Owner Name: Title.: Phone No.:

Home Address: City: State: Zip

 

Bank Reference

Bank Name: Phone No.: Contact:

Address:

City: State: Zip

 

Bank Name: Phone No.: Contact:

Address:

City: State: Zip

 

Trade References

Company Name: Phone No.: Contact:

Address:

City: State: Zip

 

Company Name: Phone No.: Contact:

Address:

City: State: Zip

 

Company: Phone No.: Contact:

Address:

City: State: Zip

 

Authorization

All statements made herein are true and accurate to the best of our knowledge. We authorize Midwest Concrete Materials to make any and all inquiries necessary for action on this credit application. We hereby indemnify Midwest Concrete Materials and its agents from any liability resulting from the credit survey.

To submit this form, you must check that you understand & agree to this authorization.

I Agree

 

Late Charges

ALL ACCOUNTS ARE DUE THE 10TH OF THE MONTH FOLLOWING DATE OF INVOICE.

1 1/2% PER MONTH (18% PER ANNUM) LATE PAYMENT CHARGE WILL BE ADDED TO ACCOUNTS 30 DAYS PAST DUE.

TO SUBMIT THIS FORM, YOU MUST CHECK THAT YOU UNDERSTAND AND AGREE TO THE LATE CHARGES.

I Accept