CASH JONES READY MIX, LLC

Weatherford TX 76088 817-341-3130

Credit Application Must be completed in full and signed

Company Name*

Phone*

Address*

Email*

example@example.com

City State Zip*

Legal Structure

CorporationPartnershipSole Proprietor

Date Incorporated

Date

If a corporporation, please list the three major stockholders and officers. If a Partnership or Sole Proprietor, please list the name, address and Social Security Number of all owners.

	Name/Title	Address	Social Security Number
Officer
Officer
Officer

Have you ever filed bankruptcy?*

YesNo

If yes,what year?

What Type

Tax Exempt:*

YesNo

If so, please attach tax exempt certificate. TAX MUST BE CHARGED UNTIL

FEIN

YEAR BUSINESS STARTED

Accounts Payable Contact*

Phone

AP Email*

example@example.com

Person Authorized to order

Credit Limit Requested

Type of Business

Bank Information

Name Bank

Address

Phone Number

Contact Person

Email

example@example.com

Credit References

Name*

Address

Phone Number

Contact Person*

Email

example@example.com

Name*

Address

Phone Number

Contact Person*

Email*

example@example.com

Name*

Address

Phone Number

Contact Person*

Email*

example@example.com

Our payment terms are PAYMENT DUE BY THE 1ST DAY OF THE MONTH FOLLOWING THE DATE OF INVOICE. Any part of the balance due not paid will be considered PAST DUE and will be charged a one and one-half percent (1 1/2%) Service Charge (annual percentage rate of 18%) on the past due

Your accont will be assigned a MAXIMUM CREDIT LIMIT, subject to review at anytime, and should your unpaid balance exceed this limit, you will be required to make a payment on your account or receive deliveries on a CASH ON DELIVERY BASIS ONLY until such time as your balance is reduced to within your credit limit. Cash Jones Ready Mix reserves the right to discontinue "CHARGE" jobs should you account become past due, if there is an ownership change, in the event of bankruptcy, or at any time Cash Jones Ready Mix, for good cause, deems itself insecure.

The applicant hereby authorizes a full and complete investigation by Cash Jones Ready Mix and understands that Cash Jones Ready Mix will not process a "CHARGE" order until a signed and completed credit application has been submitted and approved.

Should it become necessary to place this account in the hands of an attorney for collection, applicant agrees to pay reasonable attorney's fees and all costs of collection.

This CONFIDENTIAL CREDIT APPLICATION contails all terms negotiated between the parties and may be modified only upon written agreement between Cash Jones Ready Mix and the applicant.

In consideration of the extention of credit priveledges, I/We hereby grant to Cash Jones Ready Mix a continuing guarantee of payment of this account and agree to personally guarantee payment of all indebtedness, including interest, collection costs, and expenses as stated above. This Application WILL NOT be considered unless completed and signed by an owner/officer.

I/WE HAVE READ THE TERMS OF THIS AGREEMENT AND AGREE TO BE BOUND BY THEM IN ALL RESPECTS.

SIGNATURE*

DATE*

Date

PRINTED NAME*

TITLE