Please fill out the form and print it.  Then fax it to the appropriate plant.
After faxing this document, please phone the facility you have faxed to
 

Centre Concrete Credit Application
 
 Credit Limit Requested $ Business Name
Phone Fax Years at Current Address
Full Address
Federal Tax ID# D/B/A Name (if applicable)  
Former Business Address (if less than 5 years at current address)
Type of Business Date Established How long in Business  
Mortgage Holder/Landlord Phone Address
Does state, county or city require a license?  Yes No If yes, license #
Select Type of Ownership:
1. Principal Name Title SS#
2. Principal Name Title SS#
3. Principal Name Title SS#
4. Principal Name Title SS#
Trade References:
1. Name Address Phone

Fax

2. Name Address Phone

Fax

3. Name Address Phone

Fax

4. Name Address Phone

Fax

Bank References:
1. Name Address Acct # Contact
2. Name Address Acct # Contact
3. Name Address Acct # Contact

 

 

 
Company Financial Data:
Number of Employees Est. Annual Sales Sales Area
Has the firm or any of its principals ever been Bankrupt? Yes No  
If yes, please explain
Disclaimer:
Any misrepresentation in this application will be considered evidence of fraud, since this information is the basis for the extending of credit.  As an inducement to grant credit, the undersigned warrants that the information submitted is true and correct.  You are authorized to investigate the credit references and principles listed.

If consideration for the extension of credit, said business promises to pay for all purchases within the terms agreed (NET BALANCE DUE IN 30 DAYS) and agrees to pay a service charge per month of 1-1/2% per month (18% annual percentage rate) on all past due balances.  In the event any third parties are employed to collect any outstanding monies owed by said business the undersigned agrees to pay reasonable collection costs, including attorney fees, whether or not litigation has commenced, and all costs of litigation incurred.  The undersigned represents that he/she has the authority to execute this credit agreement on behalf of the business identified.
Name of Business
Name of Signer Title   Date
Name of Signer Title   Date (if second signature required)
Personal Guarantee:
In consideration for Centre Concrete Company extending credit to the business identified above for any materials and/or services after this date at the request of applicants or its agents, the undersigned individual hereby personally guarantees unconditionally and irrevocably the prompt payment of any sums now or hereafter owed to Centre Concrete Company by the business identified above whether said sums are due under open account, contract or otherwise.

It is understood and agreed that credit, if extended, is to be on a continuing basis and may exceed estimated maximum credit limit required as stated in the credit agreement between Centre Concrete Company and the business.  Centre Concrete Company shall not be obligated to notify the undersigned of the dates or amounts of any such credit and the undersigned waives demand, notice of default and any extension of time or any other forbearance which may be extended by Center Concrete Company.

This guarantee shall continue in force until notice in writing, sent by registered or certified mail, return receipt requested is received by Centre Concrete Company.  Said notice shall specify the date on which this guaranty is to be terminated, said date not to be less than seven days after such notice is received.  Such termination shall in no way release the undersigned as to any sum or debt incurred prior to such termination.
Name    Date   SS#
Home Address   Home Phone
Name of Business whose account is personally guaranteed
I Agree with these terms  Yes No
 
 
Please fill out the credit application and fax it to the plant that you are submitting the application to.
 
State College Montoursville Lock Haven Big Flats, NY Woodland
Plant Phone: 
1-814-238-2471

Fax: 
1-814-238-2914

 Plant Phone: 
1-570-433-3186

Fax: 
1-570-433-4408

 Plant Phone: 
 1-570-748-7747

Fax: 
1-570-748-5777

 Plant Phone: 
1-607-562-3301

Fax: 
1-607-562-3011

 Plant Phone: 
1-814-857-7690

Fax: 
1-814-857-7692