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Credit Application
Credit Application PDF
- If you would like to print off this form and fax it, please fax to this number: 1-703-771-7987
Step 1 of 4 - Company Information
25%
Business Trade Name
*
Parent Company (if different)
Tax ID (EIN) or SSN
*
Corporate Headquarters Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Owner or Principal Stock Holder
*
First
Last
Social Security Number
*
Phone Number
*
Email
*
Accounts Payable Contact
First
Last
Phone Number
Fax Number
Email
Applicant Type (Select One)
Corporation
Partnership
Sole-Proprietorship
Govt/Military
Individual
State of Corporation
Year of Incorporation
Select all states where you are qualified to do business
Virginia
Maryland
District of Columbia
Other
If Other, specify:
Virginia - Business License Number
Maryland - Business License Number
DC - Business License Number
Other - Business License Number
Desired Line of Credit
USD
P.O. Required
Yes
No
Payment Method (Select One)
Check
Wire Transfer
Credit Card
Bonding Agent (if required)
Phone Number
Bank Name (Checking)
Account Number
Contact Person
*
First
Last
Phone Number
Trade References
Company Name
Account Number
Phone
Fax
Contact Person
Contact Email
I/We hereby certify that all statements made are true and complete, are submitted for the purpose of obtaining credit, and that Same-Day Aggregates, LLC and or their affiliates may rely on them for such determination. I/We authorize Same-Day Aggregates, LLC and/or its affiliates to obtain such information as you may require concerning the statements made in this application, and agree that the application shape remain the property of Same-Day Aggregates, LLC regardless of credit decision. Same-Day Aggregates, LLC May require personal guarantee(s) of the appropriate corporate officer(s) or principals of the entity requisition credit, a credit card guarantee, a bank letter of credit, and/or an operating deposit. Same-Day Aggregates, LLC is authorized to answer questions about this credit experience between Same-Day Aggregates, LLC and me/us. I certify that I/we have the appropriate authority to request credit and to enter into this arrangement, if approved. I/we also understand that there is no obligation to purchase services or products from Same-Day Aggregates, LLC and/or its affiliates, regardless of credit decision.I/we understand and agree that the terms of credit are at the discretion of Same Day Aggregates, LLC. if our account remains outstanding for more than 10 days, i/we agree to pay a finance charge of 2% per month on any outstanding balance. if all or any part of this account should become overdue and placed in the hands of attorney or other agency for collection, you will be required to pay attorney and/or collection fees of a reasonable amount allowed by law.I/we sign this agreement in good faith and understand that signing this application is your consent to obtain a consumer credit report and to contact our bank and trade references to evaluate our credit in connection with this application.
I agree to the TERMS AND CONDITIONS above and hereby certify that the information presented herein is correct to the best of my knowledge.
*
Yes
No
Name
First
Last
Title of Applicant
Today's Date
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