740-927-4500 HOME WHAT WE OFFER ABOUT US OPPORTUNITIES LOCATIONS CONTACT Credit Application If you prefer to print this application and fax it to us, you may do so by filling out this form and clicking print at the bottom of the page rather than submitting it online. BUSINESS CONTACT INFORMATION Company Name* Phone* Fax Email* Business Address* Street Address Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State ZIP Code Date business commenced:* Date Format: MM slash DD slash YYYY Type of Business Entity* Sole Proprietorship Partnership Corporation Limited Liability Company Other Estimated Yardage Purchase per Month:* Please enter a number from 1 to 9999. BUSINESS AND CREDIT INFORMATION Is your contact address and primary business address the same?* Yes No Bank Name* Bank Contact* First Last Bank Phone* BUSINESS/TRADE REFERENCES (3) 1. Company Name* Address* Street Address Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State ZIP Code Phone Fax Email Type of Account: 2. Company Name* Address* Street Address Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State ZIP Code Phone Fax Email Type of Account: 3. Company Name* Address* Street Address Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State ZIP Code Phone Fax Email Type of Account: TERMS OF CREDIT AGREEMENT All invoices are to be paid 30 days from the date of the invoice. A service charge of one and one half percent (1 ½%) per month will be charged on all delinquent balances. No separate invoices will be issued for service charges. In the event of default and/or this account is turned over to an agency for collection, the undersigned applicant agrees to pay all collection cost and expenses, which may include attorney fees and court costs; whether or not suit is filed or judgment rendered. Applicant agrees to provide copies of any Notice of Commencements in their procession for a particular job at the time of placing an order; or within 10 days of its receipt. Claims arising from invoices must be made within fourteen working days. By submitting this application, you authorize Scioto Ready Mix LLC to make inquiries into the banking and business/trade references that you have supplied, and additionally authorize your banking and business/trade references to respond to Scioto Ready Mix LLC inquiries regarding your account. I acknowledge that I have read and agree to the terms above.* Yes, I agree SIGNATURES Name/Signature* First Last TItle By typing your name you agree that this is a legally binding document and you agree to the terms and conditions therein. Furthermore, you agree that your typed name shall have the same effect as your original signature. Date* Date Format: MM slash DD slash YYYY Name/Signature First Last Title By typing your name you agree that this is a legally binding document and you agree to the terms and conditions therein. Furthermore, you agree that your typed name shall have the same effect as your original signature. Date Date Format: MM slash DD slash YYYY Verification* I/We have e-signed this document. The above named individual acknowledges that he/she has electronically signed this credit application and, furthermore, intends the above e-signature to be valid and enforceable in a court of law. Unconditional Personal Guarantee For valuable consideration, the receipt of which is hereby acknowledged; including but not limited to the extension of credit by Scioto Ready Mix LLC to the above applicant, hereafter Obligor, the undersigned jointly and severally, unconditionally guarantee to Oblige the full and prompt payment of Obligor, of all obligations which Obligor may have to Oblige presently or hereafter. Further, the undersigned agrees to indemnify Oblige against any losses Oblige may sustain and expenses Oblige may incur as a result of any failure of Obligor to perform. Including all invoice charges, interest carrying charges, service charges, attorney fees, court costs, and all other cost which may be associated with the collection of this debt. Name/Signature* First Last By typing your name you agree that this is a legally binding document and you agree to the terms and conditions therein. Furthermore, you agree that your typed name shall have the same effect as your original signature. Date* Date Format: MM slash DD slash YYYY Verification* I have e-signed this document. The above named individual acknowledges that he/she has electronically signed this credit application and personal guarantee. Furthermore, he/she intends the above e-signature to be valid and enforceable in a court of law. CAPTCHA Print This Application Copyright © 2016, Scioto Ready Mix, Inc.