Credit Application

Credit Application
Authorized Employee Information
Name*

First NameLast Name
Title/Position*
Email*
example@example.com
Company Information
Name of Company*
Tax ID Number*
Type of Business*
In Business Since*
In Business Since*

MonthDayYear
Date
DUNS
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Physical Address (if different than mailing address)

Street Address

Street Address Line 2

CityState

Zip Code
A/P Contact*

First NameLast Name
A/P Email*
example@example.com
A/P Phone*
A/P Address (if different from mailing address above)

Street Address

Street Address Line 2

CityState

Zip Code
Tax Exempt*

NoYes (please attach certificate)
File Upload

Cancelof
Bank References
Institution Name*
Checking Account #
Contact Person *

First NameLast Name
Contact Person Phone Number*
Address

Street Address

Street Address Line 2

CityState

Zip Code
Institution Name 2
Checking Account #
Contact Person

First NameLast Name
Contact Person Phone Number
Address

Street Address

Street Address Line 2

CityState

Zip Code
Trade References
Company Name*
Contact Name

First NameLast Name
Phone Number*
Account opened since

MonthDayYear
Date
Current Balance
Credit Limit
Address

Street Address

Street Address Line 2

CityState

Zip Code
Company Name 2*
Contact Name

First NameLast Name
Phone Number*
Account opened since

MonthDayYear
Date
Current Balance
Credit Limit
Address

Street Address

Street Address Line 2

CityState

Zip Code
Financial Information
Company Total Assets
Annual Net İncome
Amount of Credit Requested*
UP Representative*
Have you or your officers or affilates ever filed a petition in bancruptcy?*

YesNo
If so, describe
Is your company subject to any litigation?*

YesNo
If so, describe
Terms & Conditions

In consideration of the extension of credit by Upstate Precast, LLC (dba Upstate Precast), the undersigned customer does hereby agree:
1. To pay all invoices in full on the designated due date, in accordance with the payment terms stated on the invoices.
2. Claims arising from invoices must be made within seven working days of customer's receipt of invoice.
3. Upstate Precast's standard terms and conditions shall govern all sales.
4. Customer is responsible for paying all finance charges accruing on late payments and for reimbursing Upstate Precast for all costs and expenses, including reasonable attorney fees, whe customer fails to pay within a timely manner, as stated in the terms and conditions.
5. Upstate is authorized to contact, obtain, and investigate all bank and trade references, obtain credit reports, verify financial information, and make inquiries as deemed necessary to determine eligibility and/or maintaining credit terms.
6. Purchases made on credit are in connection with business, commercial, and/or industrial transactions and are not for personal, family, household, or agricultural purposes or uses. Extended credit shall be "trade credit" as used in 12 C.F.R. § 1002.9.
By signing below, customer acknowledges, accepts, and agrees to Upstate Precast's Terms and Conditions and certifies, represents, and warrants that all the information provided herein is true, correct, and complete.
Signature*

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Credit Application

Authorized Employee Information

Company Information

Bank References

Trade References

Financial Information