WADES CONCRETE LLC.,
dba KATIES KONCRETE
CREDIT APPLICATION
Send Credit Application To:
Katies Koncrete DATE:
206 West Water Street COMPANY NAME:
Addison, NY 14801
Phone: (607) 359-3436 ADDRESS:
Fax: (607) 359-3652
PHONE: FAX:
FEDERAL ID or SOCIAL SECURITY NUMBER:
TYPE OF BUSINESS: (please check applicable) DATE STARTED:
CORPORATION: PARTNERSHIP: OTHER:
ACCOUNTS PAYABLE CONTACT PERSON:
PRINCIPAL OFFICERS, HOME ADDRESSES, AND SOCIAL SECURITY NUMBERS
ARE YOU TAX EXEMPT: YES NO IF YES, PLEASE SEND US A TAX EXEMPT CERTIFICATE.
JOB NAME OR P.O. REQUIRED? YES NO IF YES, PLEASE PROVIDE:
WADES CONCRETE IS NOT RESPONSIBLE FOR WRONG JOB INFORMATION GIVEN FOR ORDERS
BANK NAME AND ADDRESS:
BANK PHONE: CONTACT:
BUSINESS TRADE REFERENCES:
NAME:
ADDRESS:
PHONE:
FAX:
NAME:
ADDRESS:
PHONE:
FAX:
NAME:
ADDRESS:
PHONE:
FAX:
IN SUBMITTAL OF THIS APPLICATION TO WADES CONCRETE LLC., dba KATIES KONCRETE, I AUTHORIZE THAT ALL INFORMATION SUBMITTED IS CORRECT AND AUTHORIZE WADES CONCRETE LLC., TO CONTACT THE ABOVE REFERENCES TO DISCLOSE ANY AND ALL INFORMATION CONCERNING THE CREDIT HISTORY OF MY COMPANY AND MYSELF.
GENERAL TERMS AND CONDITIONS:
1. PAYMENTS TO BE MADE IN THE FORM OF A CHECK OR CASH.
2. PAYMENT TERMS ARE NET 30 DAYS FROM DATE OF PURCHASE.
3. A SERVICE CHARGE OF 1.5% PER MONTH WILL BE ADDED FOR DELINQUENT ACCOUNTS.
4. NO PURCHASES WILL BE MADE ON ACCOUNT IF THERE IS A PAST DUE BALANCE OWED.
5. IF MY ACCOUNT IS PLACED FOR COLLECTION I WILL BE RESPONSIBLE FOR ALL COLLECTION COSTS, INCLUDING REASONABLE ATTORNEYS FEES.
I HAVE READ THE ABOVE AND AGREE TO ALL TERMS AND CONDITIONS.
PRINTED NAME:
AUTHORIZED SIGNATURE:
DATE:
PERSONAL GUARANTEE:
THE UNDERSIGNED PERSON GUARANTEES ALL OBLIGATIONS OF THE ABOVE APPLICATION INCLUDING INTEREST, COLLECTION COSTS, AND REASONABLE ATTORNEY'S FEES. THIS GUARANTEE MAY BE REVOKED BY NOTIFYING WADES CONCRETE LLC., AT THE MAIN OFFICE IN WRITING.
PRINTED NAME:
AUTHORIZED SIGNATURE:
DATE:
dba KATIES KONCRETE
CREDIT APPLICATION
Send Credit Application To:
Katies Koncrete DATE:
206 West Water Street COMPANY NAME:
Addison, NY 14801
Phone: (607) 359-3436 ADDRESS:
Fax: (607) 359-3652
PHONE: FAX:
FEDERAL ID or SOCIAL SECURITY NUMBER:
TYPE OF BUSINESS: (please check applicable) DATE STARTED:
CORPORATION: PARTNERSHIP: OTHER:
ACCOUNTS PAYABLE CONTACT PERSON:
PRINCIPAL OFFICERS, HOME ADDRESSES, AND SOCIAL SECURITY NUMBERS
ARE YOU TAX EXEMPT: YES NO IF YES, PLEASE SEND US A TAX EXEMPT CERTIFICATE.
JOB NAME OR P.O. REQUIRED? YES NO IF YES, PLEASE PROVIDE:
WADES CONCRETE IS NOT RESPONSIBLE FOR WRONG JOB INFORMATION GIVEN FOR ORDERS
BANK NAME AND ADDRESS:
BANK PHONE: CONTACT:
BUSINESS TRADE REFERENCES:
NAME:
ADDRESS:
PHONE:
FAX:
NAME:
ADDRESS:
PHONE:
FAX:
NAME:
ADDRESS:
PHONE:
FAX:
IN SUBMITTAL OF THIS APPLICATION TO WADES CONCRETE LLC., dba KATIES KONCRETE, I AUTHORIZE THAT ALL INFORMATION SUBMITTED IS CORRECT AND AUTHORIZE WADES CONCRETE LLC., TO CONTACT THE ABOVE REFERENCES TO DISCLOSE ANY AND ALL INFORMATION CONCERNING THE CREDIT HISTORY OF MY COMPANY AND MYSELF.
GENERAL TERMS AND CONDITIONS:
1. PAYMENTS TO BE MADE IN THE FORM OF A CHECK OR CASH.
2. PAYMENT TERMS ARE NET 30 DAYS FROM DATE OF PURCHASE.
3. A SERVICE CHARGE OF 1.5% PER MONTH WILL BE ADDED FOR DELINQUENT ACCOUNTS.
4. NO PURCHASES WILL BE MADE ON ACCOUNT IF THERE IS A PAST DUE BALANCE OWED.
5. IF MY ACCOUNT IS PLACED FOR COLLECTION I WILL BE RESPONSIBLE FOR ALL COLLECTION COSTS, INCLUDING REASONABLE ATTORNEYS FEES.
I HAVE READ THE ABOVE AND AGREE TO ALL TERMS AND CONDITIONS.
PRINTED NAME:
AUTHORIZED SIGNATURE:
DATE:
PERSONAL GUARANTEE:
THE UNDERSIGNED PERSON GUARANTEES ALL OBLIGATIONS OF THE ABOVE APPLICATION INCLUDING INTEREST, COLLECTION COSTS, AND REASONABLE ATTORNEY'S FEES. THIS GUARANTEE MAY BE REVOKED BY NOTIFYING WADES CONCRETE LLC., AT THE MAIN OFFICE IN WRITING.
PRINTED NAME:
AUTHORIZED SIGNATURE:
DATE: