Customer Credit Application Application for Credit Account Terms: Eagle Ready Mix may extend credit on account on a case-by-case basis. Please allow at least two weeks for processing and account approval. Only fill out the following portion if you or your company is applying to be considered for a credit account. Eagle Ready Mix reserves the right to decline credit extension in its sole discretion. Unless otherwise approved by Eagle Ready Mix in writing, all material must be paid for at time of delivery or prior. Business Structure and Financial Information Company name * Year established * Business structure *Sole ProprietorshipPartnershipCorporationLLCOther Other: please specify Federal Tax ID Number * Dun & Bradstreet (D-U-N-S) Number(if applicable) Bank Name * Account Type *CheckingSavings Account Number * Bank Contact Name * Bank Phone * Bank Address * City * State * Zip code * Trade References Please provide contact information for three trade references (suppliers, vendors, etc.) Company name * Phone * Email address * Company name * Phone * Email address * Company name * Phone * Email address * Bank References Please provide contact information for your primary bank reference. Bank name * Bank Contact Name * Phone * Email address * Authorization and Declaration I certify that the information provided in this application is true and complete to the best of my knowledge. I authorize Eagle Ready Mix to investigate my company’s credit history and to obtain credit reports from any credit reporting agency. I fully understand that Eagle’s credit terms are net twenty (20) days if this application is approved unless agreed by the parties otherwise and agree to the prompt payment of all tickets and invoices in consideration of extended credit. Signature Your browser does not support e-Signature field. (Principal Owner/Authorized Officer) Date * SubmitSave as Draft Please do not fill in this field.
