Credit Application for a Business Account

Transcription

1 Credit Application for a Business Account Jackson Plant: Ohio Basic Minerals LLC Corporate Office: Ohio Basic Minerals LLC Beaver Pike Road 1700 Broadway Suite 1170 Jackson, OH Denver, CO (740) (720) (740) (720) Legal Company City: State: Zip: Billing Address (If Different): Type of Business: Business Structure Corporation- Publicly Held Corporation- Closely Held Partnership-General Partnership- Limited Sole Proprietorship If Corporation: If Division or Subsidiary: Date of Incorporation: State of Incorporation: Parent Subsidiaries Name(s): TAX ID Number: Estimated Monthly Purchases: Gravel: Sand: Total:

2 Bank Reference: City: State: Zip: Type of Credit Facility: Secured By: Officer Trade References: Trade References:

3 Trade References: Authorized Purchasers for Business Transactions: Accounts Payable Contact:

4 Financial Statements In order to establish credit with Ohio Basic Minerals LLC, please attach a current financial statement (which includes balance sheet, income statement, and statement of cash flows, notes to financials and auditor s notes) and/or your latest tax return These documents will be kept confidential and used for the sole purpose of establishing credit with Ohio Basic Minerals LLC. Please Send to: Ohio Basic Minerals LLC Attn: Credit 1700 Broadway Suite 1170 Denver, CO (720) (720) [email protected] Confirmation of Information Accuracy and Release of Authority to Verify The undersigned, for the purpose of procuring and establishing credit from time to time with seller and to induce seller to permit customer to become indebted to seller for purchase of goods, materials and/or services, furnished the above business and personal credit information. The undersigned, jointly and individually, certify that all information in this Credit Application and accompanying Financial Statements is complete, factual and correct and understands the seller will rely on the accuracy of this information for any credit that may be extended. Seller is hereby expressly authorized to contact any parties listed herein and to verify any information contained in the Credit Application. The undersigned hereby waives any privacy of credit information rights of regulations. If any representations made on the Application prove to be untrue, the undersigned agrees that all obligations to customer to, or held by, shall immediately become due and fully payable without demand or notice. The undersigned hereby acknowledges receipt of a copy of this Credit Application and agrees to be bound by the Credit Terms which appear below. Customer Signature: Date:

5 Credit Terms (Subject to change at any time) Terms: Limit: Credit Privileges: Service Charge: Payment terms are as printed on invoices, contracts, and current General Terms and Conditions. Invoices not paid by their due date are considered past due. Non-compliance with payment terms may result in reduction or revoking of credit. Ohio Basic Minerals LLC will assign a credit limit. Credit limits are subject to change without notice Credit privileges may be withdrawn at any time, for any reason including, but not limited to: non-payment, being past due, being over credit limit, and lack of complete information or false information. Past due accounts are subject to late payment services charges.