Credit Application Step 1 of 5 20% PhoneThis field is for validation purposes and should be left unchanged.Business Name(Required) Legal Business Name Business Email Address(Required) Business Phone(Required)How long have you operated under this name?(Required)Business Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Federal Tax Identification Number(Required)Check One(Required) Individual Partnership Corporation Credit Limit Requested(Required) 1. Owners or OfficersName(Required) First Last Title(Required)Soc. Sec. #(Required)Date of Birth(Required) MM slash DD slash YYYY Mobile Phone(Required)Email(Required) Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code 2. Owners or OfficersName First Last TitleSoc. Sec. #Date of Birth MM slash DD slash YYYY Address Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Mobile PhoneEmail References and Additional InformationInclude at least one concrete supplier.Business Name(Required)Business Phone(Required)Business Email(Required) Business Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Additional Reference 2 Add an additional reference Business NameBusiness PhoneBusiness Email Address Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Additional Reference 1 Add an additional reference Business NameBusiness PhoneBusiness Email Address Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Bank InformationBank(Required)Branch(Required)Checking Acct. #(Required)Contact(Required)Phone No.(Required)Have you ever had an account with American Concrete Inc. before?(Required) Yes No When was the Previous Project?Under What Business Name?Have you, within the past 10 years filed for personal or corporate bankruptcy?(Required) Yes No When was the bankruptcy?Under What Business Name?Have you ever been in business under any other name?(Required) Yes No Under What Business Name?Initial projects to be supplied on credit:Project Name:(Required)Project Address:(Required)Project Name:Project Address: Terms and Conditions(Required) I authorize American Concrete, Inc. to run a personal credit check in order to open my business account.1. Authorization for Credit Review - Applicant hereby authorizes American Concrete to obtain any and all information it deems necessary from any and all sources of reference listed on this Application for Credit and from any other credit bureaus, creditors of Applicant, trade references, banks, or other financial institutions. Applicant further authorizes each of such sources, references, credit bureaus, creditors, banks, and financial institutions to supply American Concrete such information as American Concrete deems necessary to assist it in its consideration of this Application. 2. Payment Terms - If this Application is accepted, Applicant agrees to pay in full the invoice price of all purchases now or hereafter made from American Concrete promptly when due according to the terms set forth on each invoice. If the total invoice price is not paid in full on or before the due date, Applicant agrees to pay a late payment charge on the unpaid delinquent balance. This late payment charge will be calculated at the rate of one and one-half percent (1 1/2%) per month unless otherwise indicated on a current invoice, in which case that rate would prevail. If Applicant should fail to fulfill any of its obligations under this Agreement, or if American Concrete in good faith deems itself insecure because the prospect of payment is impaired or the prospect of performance of any provisions of this Agreement is impaired, or if a default occurs for any other reason provided in the Agreement, then American Concrete at its option and without notice, may declare the entire unpaid balance owed by Applicant under this Agreement to be immediately due and payable, or terminate the credit privileges of Applicant under this Agreement, or both, Applicant agrees to pay in full at all costs and expenses incurred by American Concrete in collecting the amounts owed by Applicant under this Agreement, including any and all court costs and attorney's fees. 3. Venue in Litigation - Applicant acknowledges that all billings, accounts receivable, and credit functions of American Concrete are processed through its main office. Therefore, in the event of litigation between Applicant and American Concrete, the lawsuit or action, at the sole option of American Concrete, shall take place in the courts located within the same county in which American Concrete's main office is located (Richmond County, GA). Applicant hereby waives its right to litigate in any other county. 4. Default - The occurrence of any of the following events shall constitute a default under this Agreement: a) Applicant fails to fulfill any obligation of this Agreement or to perform, or rectify the breach of, any warranty, Agreement, or other undertaking of Applicant in this Agreement; b) Applicant or guarantor of Applicant's indebtedness under this Agreement, dies, terminates existence, abandons its business, becomes insolvent, bankrupt, becomes the subject of bankruptcy, receivership, insolvency, or similar proceedings, or makes an assignment for the benefit of creditors; c) Any information or other representation now or hereafter made or furnished to American Concrete by Applicant or at Applicant's request or instruction is, or is believed in good faith by American Concrete to be, inaccurate, incomplete, or false in any material respects; d) Applicant violates or breaches any provision of the Agreement; e) Any Collateral which is security for Applicant's indebtedness under this Agreement is lost, suffers material damage or destruction, is levied upon, becomes subject to a receivership, or cannot be located within five days after American Concrete demands to inspect the same; f) Any other event which causes American Concrete, in good faith, to deem itself insecure or to believe that the prospect of performance of any provision of this Agreement by Applicant is impaired. 5. Sales Taxes - Applicant agrees, that in the event American Concrete is required to pay sales taxes to the taxing authority of any State or political subdivision thereof in connection with any sale of materials to Applicant, Applicant will, upon demand, indemnify and hold harmless American Concrete for amount of any such tax paid, and for the amount of all costs or attorneys' fees incurred by American Concrete in contesting such tax. 6. Waiver - American Concrete may, at its option, permit Applicant to remedy any default under this Agreement without waiving the default so remedied or any other subsequent or prior default by Applicant. Applicant waives notice of default of this Agreement and waives presentment, demand, protest and notice of dishonor as to any instrument. 7. Binding Agreement - This Agreement shall inure to the benefit of the successors and assigns of American Concrete, and shall be binding upon Applicant's heirs, legatees, devisees, personal representatives, successors, and assigns. 8. Corporate Authority and Liability - Applicant warrants and represents that it has authority to enter into this Agreement and that any person signing this Agreement has been duly authorized to execute this Agreement for and on behalf of Applicant. If Applicant is not a corporation, Applicant acknowledges that American Concrete is relying upon the credit worthiness and financial ability of the owner and owner of Applicant and upon the business name of Applicant; therefore, in the event Applicant subsequently incorporates, the owner or owners of Applicant and the new corporation shall be liable to American Concrete for all indebtedness of Applicant then existing and thereafter incurred. 9. Accuracy of Information - Applicant certifies that any and all information now or hereafter supplied to American Concrete by Applicant, or at Applicant's request or instruction, is both accurate and complete, and Applicant will, upon request, establish the accuracy and completeness of any such information. Applicant shall promptly notify American Concrete of any adverse change in any such information supplied, and of any such change in Applicant's residence, chief place of business or mailing address, Applicant shall promptly notify American Concrete if Applicant should change his name or begin to do business under any other name. Applicant shall promptly notify American Concrete if he should incorporate this business at any time subsequent to the date of this application. 10. Provision of Information - Applicant is required to provide American Concrete, upon request, information regarding bonding companies, general contractors, or owners for the purpose of filing preliminary notices, claims on payment bonds, or mechanics and materialmen's liens. 11. Modification of Terms - The terms of this Agreement may be modified or amended by American Concrete at any time upoon thirty (30) days notice to Applicant in the invoices, or otherwise. 12. Additional Provisions - the rights and remedies of American Concrete stated in this Agreement are cumulative and are in addition to any other rights or remedies provided by law. The laws of the state in which American Concrete's main office is located (Georgia) shall govern the interpretation of this Agreement. This Agreement shall not be binding upon American Concrete or insure to the benefit of Applicant until executed by an authorized agent or officer of American Concrete. Applicant has read and hereby agrees to the terms and conditions listed above and on the reverse side of this application for Credit. Company NameCompany Position Held by SignerBy signing below, I certify that the information provided in this application is true and complete to the best of my knowledge, and I agree to the terms and conditions stated above.Printed Name of Signer First Last