Confidential Credit Application

Step 1 of 3

Company Name(Required)

Federal ID #(Required)

Address(Required)

Street Address / PO Box Address Line 2 City State Zip

Years Est.(Required)

Business/Cell Phone(Required)

Fax

Email(Required)

Bank Name(Required)

Bank Location(Required)

Bank Phone(Required)

Bank Account #(Required)

Bank Contact Name(Required)

First Last

Kind of Business(Required)

Corporation

Partnership

Individual

Tax Exempt?(Required)

Yes (Attach Certificate)

Tax Exemption Certificate(Required)

Accepted file types: doc, docx, pdf, Max. file size: 128 MB.

Corporate Officer and/or Owners(Required)

Owner/Officer's Name

Address

Title

SS #

Home / Cell Phone

References

List 5 active major material suppliers. Failure to provide the correct name, phone number and email address for the credit department of your references will result in the credit process being delayed.

Reference 1 Name(Required)

First Last

Reference 1 Phone(Required)

Reference 1 Email(Required)

——————–

Reference 2 Name(Required)

First Last

Reference 2 Phone(Required)

Reference 2 Email(Required)

——————–

Reference 3 Name(Required)

First Last

Reference 3 Phone(Required)

Reference 3 Email(Required)

——————–

Reference 4 Name(Required)

First Last

Reference 4 Phone(Required)

Reference 4 Email(Required)

——————–

Reference 5 Name(Required)

First Last

Reference 5 Phone(Required)

Reference 5 Email(Required)

Have You Been in Business Before?(Required)

Yes

Previous Business(Required)

Previous Business Address(Required)

Street Address Address Line 2 City State Zip

Date of Previous Business

From(Required)

To(Required)

Type of Previous Business(Required)

Agreement

We believe our firm is financially able to meet any commitments we have made. We expect to pay our invoices according to the terms stated below.

We will honor all Metal Culverts, Inc., invoices within these terms and acknowledge that payments for goods received from Metal Culverts, Inc., will NOT depend on the collection of funds owed to our company by our customers.

Terms: All payments are due 30 days from invoice date and any account past due 90 days will be placed cash on delivery. Past due accounts are subject to late payment charge at the highest rate permitted by law not to exceed 1.5% per month and are liable for all legal and/or fees that may result from any collection efforts on the Principals and the Company as listed above.

Corporation: Two officers must sign.

Partnership: All partners must sign.

Individual: Both Spouses must sign.

Signature(Required)

Additional Signatures

Signature(Required)

Date

PROJECT INFORMATION SHEET

The following information must be completed prior to the start of production. Purchase orders must identify the project and materials.

Description of Materials(Required)

Project Start Date(Required)

Amount of Materials(Required)

Customer Information

Customer Name

First Last

Customer Address(Required)

Street Address Address Line 2 City State Zip

Customer Phone(Required)

Owner(Required)

First Last

Prime Contractor(Required)

First Last

Sub Contractor(Required)

First Last

Other

First Last Position

Prime Contractor Information

Prime Contractor Name(Required)

First Last

Prime Contractor Address(Required)

Street Address Address Line 2 City State Zip

Prime Contractor Phone(Required)

Prime Contractor Email(Required)

——————–

Bonding Company Name(Required)

First Last

Bonding Company Address(Required)

Street Address Address Line 2 City State Zip

Bonding Company Phone(Required)

Bonding Company Email(Required)

Project Information

Project Owner(Required)

(As listed with County Recorder’s Office.)

Project Owner Address(Required)

Street Address Address Line 2 City State Zip

Project Owner Phone(Required)

Project Owner Email(Required)

——————–

Project Name(Required)

Parcel ID #(Required)

Project Address(Required)

Street Address Address Line 2 City State Zip

County(Required)

Book #(Required)

Page #(Required)

Title Company

Missouri Customers Only

Title Company Name

Title Company Address

Street Address Address Line 2 City State Zip

Title Company Phone

Title Company Email

Signature

Date

CREDIT REPORT AUTHORIZATION AND RELEASE

Authorization is hereby granted to Metal Culverts, Inc. (“MCI”) to obtain a standard factual data credit report on the undersigned company (“Applicant”) through a credit reporting agency chosen by MCI. In addition, Applicant authorizes MCI to contact all credit references disclosed to MCI, and authorizes such credit references to release to MCI all credit and payment history requested by MCI.

Applicant authorizes the release to the credit reporting agency a copy of Applicant’s credit application, and authorizes the credit reporting agency to obtain information regarding Applicant’s credit and payment history. Authorization is further granted to the reporting agency to use a photocopy reproduction of this authorization if necessary to obtain any information regarding the above mentioned information.

Any reproduction of this credit report authorization and release made by reliable means (for example, photocopy or facsimile) is considered an original.

Applicant’s Name(Required)

First Last

Credit Signature 1(Required)

Credit Signature Date 1(Required)

Additional Signatures

Credit Signature 2(Required)

Credit Signature Date 2(Required)

Credit Signature 3(Required)

Credit Signature Date 3(Required)

Credit Signature 4(Required)

Credit Signature Date 4(Required)

Confidential Credit Application

References

Agreement

PROJECT INFORMATION SHEET

Customer Information

Prime Contractor Information

Project Information

Title Company

CREDIT REPORT AUTHORIZATION AND RELEASE

Metal Culverts, Inc

Products

Company