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• CREDIT APPLICATION

  Please complete the following application and submit to King Asphalt, Inc. Applications can be submitted online, in person at the office, mailed, faxed, or emailed.

• Contact Information

• Customer/Company Name*
• Mailing Address
  Street Address Address Line 2 City 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 State ZIP Code
• Address
  Street Address Address Line 2 City 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 State ZIP Code
• Phone Number
• Fax Number
• A/P Contact Name
• Mobile Number
• Email

• Business Description

• Description of Business
• Years:
• Parent Company
• Physical Address
  Street Address Address Line 2 City 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 State ZIP Code
• Corporation
• Partnership
• Proprietorship
• Full Names(s) of Officers, Partners or Proprietor
• Title
• Full Names(s) of Officers, Partners or Proprietor
• Title

• Credit References

• Trade Reference 1:
  Please Include Name, Address, Phone, & Fax Number
• Trade Reference 2:
  Please Include Name, Address, Phone, & Fax Number
• Trade Reference 3:
  Please Include Name, Address, Phone, & Fax Number

• Terms and Conditions

• Applicant’s signature attests financial responsibility, ability and willingness to pay our invoices in 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, shall 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 reasonably 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 §29-6-50 are hereby waived.

• General Provisions

• This 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 application 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 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 P.O. Box 179, Liberty SC 29657 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 costs of collection including 15% 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 find check.
• Authorized Signature*
• Printed Name of Person Signing*
• Title of Person Signing*

• Personal Guaranty

  This undersigned hereby personal guarantees payment when due of all indebtedness now due or which may hereafter become due by Applicant to King Asphalt, Inc.
• Signature*
• Date Signed*
  MM slash DD slash YYYY