Credit Application

Credit Application

PO Box 795, Greenwood, IN 46142 | 317-881-9754 | fax: 317-889-0383
Company Name
Shipping Address

Address

Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Fax Number
Type of Business
Dunn & Broadsheet No.
Legal Form Under Which Business Operates

CorporationPartnershipProprietorshipOther
Incorporation Date
State of Incorporation
EIN No.
A/P Contact Name
A/P Contact Email
A/P Contact Phone No. & Ext.

Partners or Corporate Officers

	Name	Title	Address	Phone No.

Bank References

	Bank Name	Contact Name	Account Number	Phone No.	Fax No.

Trade References (minimum of 3)

	Name & Address	Phone No.	Fax No.

TERMS ARE NET 30 DAYS. We have the right to put account on hold until all past due amounts are paid in full.

Applicant agrees to pay any collection costs incurred to collect the unpaid balance, including interest on the unpaid balance as allowed by state law and any reasonable attourney's fees incurred.

The Undersigned as in Inducement to grant credit warrants that the information submitted is true and correct. You are authorized to investigate the credit references above.
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PERSONAL GUARANTEE

In consideration of credit being extended by Liquid Waste Removal, Inc., to the above named applicant for services to be purchased whether applicant be an individual or individuals, a proprietorship, a partnership, a corporation, or any other entity, the undersigned guarantor or guarantors each hereby contract and guarantee to Liquid Waste Removal, Inc., the faithful payment, when due, of all accounts of said applicant for purchase made within five years next after the date of application. The undersigned guarantor or guarantors each hereby expressly waive all notice of acceptance of this guarantee, notice of extension of credit to applicant, presentment, and demand for payment on applicant or with respect to any security held by
First Name* Last Name*, extension of time of payment to applicant, acceptance of partial payment or partial compromise, all other notices to which the undersigned guarantor or guarantors might otherwise be entitled and demand payment under this guarantee. Any revocation of the guarantee shall be in writing and delivered to Liquid Waste Removal, Inc.
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