Online Credit Application

Thank you for taking time to complete this application. To enable us to give you the best service and complete satisfaction in processing this application for credit, please complete the information below completely before submitting.. If you would like to download this application and fax it in to us click here to: Download Credit Application.

Section A - Applicant Information (Please enter dates in any formats: MM/DD/YY, MM/YY, or YYYY)

Business Name

Corporation Partnership LLC

Proprietorship Non-Profit LLP

If Corp. Inc. In What State?

Date of Incorporation

Designated Corporate Agent

Corporate ID Number

Business Address

City

State

Zipcode

At Present Location Since

Phone

Fax

Mailing Address

City

State

Zipcode

Type of Business

Year Established

Employer ID

Contractor License No.

Resale No.

Email Address

Section B - Trade References (Open Accounts Only)

Name

Address

City

State

Zipcode

Phone

Contact Person

Account Number

Name

Address

City

State

Zipcode

Phone

Contact Person

Account Number

Name

Address

City

State

Zipcode

Phone

Contact Person

Account Number

Name

Address

City

State

Zipcode

Phone

Contact Person

Account Number

Section C - Bank References

Bank Name

Account Number

Phone Number

Address

City

State

Zipcode

Bank Name

Account Number

Phone Number

Address

City

State

Zipcode

Statement Of Policy

It is understood and agreed upon by the undersigned applicant and Southeast Construction Products. Inc. that the applicant may obtain merchandise and/or services on credit pursuant to the following terms:

1. The Applicant will pay in full all invoices on or before the tenth (10th) of each month following the date of purchase.

2. The account will be considered past due if not paid in full according to the terms above, and any amount which becomes past due will be subject to an additional 1 1/2 % per month service charge for costs incurred to Southeast Construction Products, Inc. for the collection of the past due account. Should the account remain past due, the applicant will also pay reasonable attorney’s fees which Southeast Construction Products, Inc. may suffer as a result of any manner of collection of any amount due on the account.

3. Southeast Construction Products, Inc. reserves the right to reassign any account to a cash basis and declare the entire unpaid balance as being due immediately if at any time the applicant fails to comply with the above terms.

Section D:

In the event credit is extended to the applicant, it is agreed that the undersigned shall be personally, jointly and severally responsible with the applicant for the payment of credit so extended.

Full Name

Signature (Type "I Agree")

Date

Address

City

State

Zipcode

Home Phone

Driver's License No.

Social Security No.

Date of Birth

Full Name

Signature (Type "I Agree")

Date

Address

City

State

Zipcode

Home Phone

Driver's License No.

Social Security No.

Date of Birth

Full Name

Signature (Type "I Agree")

Date

Address

City

State

Zipcode

Home Phone

Driver's License No.

Social Security No.

Date of Birth