Felton Brothers Transit Mix, Inc.

*

Sole Proprietorship

Corporation

Partnership

Individual

Are you Tax Exempt? *

If yes tax exemption certificate is required.

Yes

No

Are you Bonded? *

Yes

No

Do you Require Purchase Orders?

Yes

No

Do you Pay by Invoice or Statement?

Invoice

Statement

*

I understand that the above is for and in consideration of the extension of credit for the purchase of goods, materials and services. The applicant agrees to furnish any additional financial information, including but not limited to current financial statements, personal or corporate, from time to time as requested by the credit grantor. To pay amounts due within stated terms for materials as purchased and applicant understands that credit can be suspended at option of credit grantor for payments not so paid. To pay finance charges (delinquent charges) of 1 1/2% per month on any and all balances that are past due stated terms for payment. To inform credit grantor of any changes of the above requested information.

I hereby authorize Felton Brothers Transit Mix, Inc. to verify my trade reference accounts. I further authorize Felton Brothers Transit Mix, Inc. to order a consumer credit report and verify other credit information, if needed.