Concrete Lake of the Ozarks : Credit Application for Scotts Concrete

Credit Application

Complete the credit application below and Scott's Concrete will contact you about establishing a credit account with our company.

PERSONAL INFORMATION

Name:

Mailing Address:

Physical Address:

City:

State:

Zip:

Telephone:

Fax:

Email:

Account Type:

If you are an individual, please enter your Social Security Number:
If this is a partnership, please list partners:
If this is a corporation, please list officers:

Are you exempt from Sales Tax?

If you chose yes, you will need to provide a copy of your exemption certificate.

TRADE REFERENCES
Contact information of suppliers your from on open account:

Reference 1

Phone: Fax:

Reference 2

Phone: Fax:

Reference 3

Phone: Fax:

BANK REFERENCES
Contact information of bank or other lending institution where you currently have accounts:

Account Name

Account #: Phone:

Account Name

Account #: Phone:

Account Name

Account #: Phone:

AUTHORIZATION TO RELEASE CREDIT INFORMATION

By executing this credit application, the undersigned hereby authorize all persons, corporations and banks listed in the above trade references and bank references sections, to release any and all information requested to Dredging, Inc.

I agree

TERMS AND CONDITIONS

In consideration for credit on open account, the applicant agrees to the terms and conditions set out below.

All invoices are due on the 10th of the month following the date of purchase, unless otherwise stated on the delivery ticket. A month finance charge of 1 1/2% will be assessed to any past due balance and it will become part of that balance. Applicant agrees to pay all costs of collection, including reasonable attorney fees and court costs, should the balance not be paid when due. Dredging, Inc reserves the right, in its discretion, to terminate credit at any time. Unless notified in writing to the contrary, any person in the employ of, or agent of the applicant who places an order for the applicant or acknowledges receipt of materials for the applicant shall be considered to have the authority to place such order or be those shown on the delivery ticket. The prices charged for material and labor shall be those shown on the delivery ticket and should there be any objection by the applicant to the price shown thereon, the materials and/or labor must be rejected by applicant upon attempted delivery. The applicant agrees to notify Dredging, Inc., should there be any change in the form of applicant's business entity (e.g. incorporation). Until such written notification is received, all charges shall continue to accrue on the established open account of applicant.

I agree

CONSENT OF OWNER

CONSENT IS HEREBY GIVEN FOR FILING OF MECHANIC'S LIENS BY ANY PERSON WHO SUPPLIES MATERIALS OR SERVICES FOR THE WORK DESCRIBED IN THIS CONTRACT ON THE PROPERTY ON WHICH IT IS LOCATED IF HE IS NOT PAID.

I agree

PERSONAL GUARANTEE

I/We have read and agree to the terms and conditions as set forth above and personally guarantee payment of this account, with costs of collections as set forth above.

I agree

Date:

You will be redirected to the home page upon submission of this application.

Contact
Scott's Concrete

Concrete Dispatch
573-317-0921

Three Locations to Serve You!
Camdenton
Lake Ozark
Climax Springs

Office
888-346-2450
573-346-2450

Jane Martin
President and CEO

Scott Martin
Vice President of Operations

Bryan Broderick
Polished Floors and Concrete Specialties

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Credit Application

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Contact Scott's Concrete

Contact
Scott's Concrete