Central Iowa Ready Mix - Credit Application

STANDARD CREDIT APPLICATION AND AGREEMENT

All questions must be answered.The person completing this Application and Agreement must be authorized to do so.

Please fill out the form below and submit. Please be as detailed as possible.

Date:

Name of Applicant's Business:

Amount of Credit Desired:

Authorized Representative Name:

Title:

Tax Identification Number:

Duns#:

Type of Business:

Date Business Started:

Corporation

Limited Liability Company

Organized in the State of:

Sole Proprietorship

Partnership: (If applicable list all Managing Members and/or Partners in the text box below)

Billing Address:

Phone Number (Work):

Phone Number (Home):

Phone Number (Mobile):

Phone Number (Fax):

At Present Address Since:

Present Management Since:

Any Branch Locations?

Address of Branches:

Name & Address of Bonding Company (use text box below to provide this information):

Applicant's A/P Contact:

Direct Phone Number:

Iowa Contractor #

Type of Business Operation? (select the appropriate box below)

Commercial Contractor

Commercial Subcontractor

Residential Contractor

Other

Describe:

Use Purchase Order #

Name of Purchasing Agent :

The Applicant must provide full, complete and accurate information, and authorizes the Company to collect from the Applicant's creditors and lenders, without restriction, such financial information as the Company solely determines to be necessary.

VENDOR REFERENCES - Complete for your four largest vendors.

Name

Contact Person

Phone and Fax Number

Amount Currently Due

Aging Date

Relationship Began

BANK REFERENCES - List current bank contacts.

Bank's Name

Contact Person

Phone and Fax Number

COMPLETE IF APPLYING FOR SPECIFIC PROJECT CREDIT

Project's Name:

Project's Address:

If Applicant is a Subcontractor, list the Project's General Contractor:

General Contractor:

Phone Number:

Project's Owner:

Phone Number:

Applicant's Client (if different from the Owner):

Contact Person:

Phone Number:

Maximum Credit Requested:

Requested Credit Time Period (months or dates):

Does the Applicant have project-financing arranged?

Yes

If yes, complete the information below

Lender's Name:

Contact:

Phone Number:

AUTHORIZATION: The Applicant understands and agrees without reservation that as a condition of the Company considering offering the Applicant credit, the Applicant will provide complete, accurate and truthful information to all questions contained herein, authorizes the Company to conduct such credit investigations as the Company solely judges to be appropriate, and will cooperate with the Company to use such information as the Company solely determines is appropriate. Applicant further agrees to allow the Company to contact project owners and general contractors on any projects covered by this Application to verify all of the information provided within or relevant to this Application. This authorization for verification includes a consent of the Applicant to allow the Company to verify banking information and account details, and payment bonds details relating to the Applicant. Further, the Applicant and all its partners, shareholders, members, or owners thereof authorize Company to obtain credit reports, and to review their credit and employment histories and any other information in order to approve or decline this application, service the Applicant's account, and manage the Applicant's relationship with the Company.

CREDIT TERMS: THE APPLICANT AGREES THAT IF CREDIT IS EXTENDED BY THE COMPANY TO THE APPLICANT, IT IS A CONDITIONAL OFFER, AND THAT CREDIT MAY BE WITHDRAWN WITHOUT NOTICE. The Applicant will, without reservation, comply with their established credit limit, pay all amounts when due, and pay all service charges, collection costs, and attorney fees which the Company may incur in collecting any amounts due to the Company from the Applicant. Payment disputes or claims pertaining to deliveries or products at one address or project will not be used as an offset against payment at any other address. Any amounts not paid within 30 days after the invoice date are past due, and will incur a service charge of 1 ½ % per month (18% per annum) which will be added to the account's balance and continue to accrue until paid. The Company reserves the right to require payment of any amounts due by a joint-payee check from the Applicant's customer, and to require personal guarantees.

TERMS AND CONDITIONS OF SALE: Applicant agrees to comply with the Company's Term and Conditions of Sale, which are available for review during regular business hours at the Company's business office.

INDEMNIFICATION: Applicant agrees to indemnify the Company for any alleged damages, costs, or expenses, including attorney's fees and costs resulting from a product failure as a consequence of the Applicant altering the Company's product.

IF THIS APPLICATION IS APPROVED BEFORE CREDIT CAN BE ISSUED A PRINTED COPY OF THIS DOCUMENT WILL BE PROVIDED FOR THE APPROPRIATE SIGNATURES.

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To complete the application and send to Central Iowa Ready Mix use the submit button below: