Application For Business Credit Customer/Company(Required) Mailing Address(Required) Street Address Address Line 2 City StateAlabamaAlaskaAmerican 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 State ZIP Code Physical Address(Required) Street Address Address Line 2 City StateAlabamaAlaskaAmerican 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 State ZIP Code Telephone Number(Required)Fax Number(Required)A/P Contact Name(Required) First Last Cell Number(Required)Driver's License Number(Required) SS# or FEI#(Required) Email(Required) Description of Business(Required) Years?(Required) Parent Company(Required) Business DescriptionBusiness Address(Required) Street Address Address Line 2 City StateAlabamaAlaskaAmerican 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 State ZIP Code Corporation(Required) Partnership(Required) Proprietorship(Required) Full Name of Officers, Partner or Proprietor(Required) Title(Required) Full Name of Officers, Partner or Proprietor Title Credit ReferencesTR. Ref. #1(Required) First Last TR. Ref. #1 Address(Required) Street Address Address Line 2 City StateAlabamaAlaskaAmerican 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 State ZIP Code TR. Ref. #1 Phone(Required)TR. Ref. #1 Fax(Required)TR. Ref. #1 Bank(Required) TR.Ref. #1 Account Number(Required) TR. Ref. #2 First Last TR. Ref. #2 Address Street Address Address Line 2 City StateAlabamaAlaskaAmerican 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 State ZIP Code TR. Ref. #2 PhoneTR. Ref. #2 FaxTR. Ref. #2 Bank TR. Ref. #2 Account Number Terms and ConditionsApplicant's signature attests financial responsibility, ability and willingness to pay our invoices I accordance with our terms. Invoices are payable thirty (30) days from invoice date. A late fee of 1.5% per month, compounded daily or as often as allowed by law, hall be charged on all past due payments. Customer shall also be responsible for all costs and expenses incurred in the collection of the debt, plus any post-judgment collection efforts, including reasonable attorney fees in the amount of; not less than one-third (33 1/3%) of the outstanding debt of judgment principal plus interest (or the maximum amount permitted by law if less than one-third), or the amount of reasonable attorney fees actually incurred, whichever amount is greater. To the extent allowed by law, the payment and interest provisions contained herein shall control and the provisions of S.C. Code Ann. §29-6-30 and §29-6-SO are hereby waived. General ProvisionsThis application and the information contained herein is a request for the extension of credit. The applicant authorizes King Asphalt, Inc. to obtain a written or oral contract report from any credit reporting agency. The applicant further authorizes any bank or commercial business with whom the applicant is doing or has done any type of business to give any and all necessary information to King Asphalt, Inc. which will assist in the credit investigation. The applicant further authorizes King Asphalt, Inc. to reinvestigate the applicant's credit status from time to time as King Asphalt, Inc. deems necessary. Should King Asphalt, Inc. deem it necessary to limit or terminate the credit arrangement with applicant, said applicant will be notified in writing along with King Asphalt, Inc.'s terms of sale, and should applicant at some time deviate from King Asphalt, Inc.'s terms of sale, King Asphalt, Inc., reserves the right to terminate future extension of credit to applicant. The undersigned does hereby certify that he/she is authorized to sign this application on behalf of the Applicant; that the information contained herein is true; that the Applicant will advise King Asphalt, Inc. in writing at address shown above if there are any changes which occur in respect to any of the information and until such advice is given King Asphalt, Inc. may continue to rely on the information; that Applicant will promptly pay any and all indebtedness that Applicant may now or hereafter owe to King Asphalt, Inc., with all cost of collection including 15 percent of the principal and interest as attorney's fees if collected by law or through an attorney at law; that Applicant shall pay to King Asphalt, Inc. a charge of $30.00 or 5% of the amount of any non-sufficient fund check given for payment toward any indebtedness, whichever is greater, for each non-sufficient fund check. Consent(Required) I agree to the privacy policy.Personal GuarantyThe undersigned hereby personally guarantees payment when due of all indebtedness now due or which may hereafter become due by Applicant to King Asphalt, Inc. Consent(Required) I agree to the privacy policy.PhoneThis field is for validation purposes and should be left unchanged.
