Credit Application Form

Business Name*

Date Established*

Date

Street Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone*

Please enter a valid phone number.Format: (000) 000-0000.

Fax

General Email*

A/P Email if Different

Accts. Payable Contact*

Current Ready Mix Supplier*

CorporationSole ProprietorLTD PartnershipPartnership

Corporation FID#*

Date & State Incorporated*

SS#*

DeveloperGeneral ContractorSubcontractorOther

Contractors License #*

Date Issued*

Date

Average Yards Poured per Week?*

Approx. How Many Slabs per Month?

Name & Address of Principle Officers, Owners, or Partners*

Trade References (No Banks)*

Credit/Sales Application: In consideration of the extension of credit by Drake Ready Mix, Inc., under its terms of sale as stated herein, the undersigned hereby agrees to its terms of sale as follows or as amended by written notice:

Mix Term of Sale: If a delinquent account is placed into hands of attorney or collection agency, purchaser shall be liable for all cost of collection, including, but not limited to an attorney fee equal to the greater of 33 1/3 % of the monies due to Drake Ready Mix, Inc., or an attorney fee equal to the hourly fee charged by Drake Ready Mix, Inc. attorneys multiplied by the hours expended by said attorneys. Attorneys’ fee shall be paid by applicant when incurred for consultation, trial or whether suit be brought or not. The terms of this agreement shall be governed by the state of Florida and the parties submit to the jurisdiction of the state of Florida. Venue of settlement for any disputes arising under this agreement, including litigation, regardless of place of payment, shall be in a forum of court as required, of competent jurisdiction in Lee County, Florida and the undersigned waives any venue rights he may posses and agrees that shall contest that Lee County, Florida is a convenient forum. The undersigned waives all rights to a trial by Jury. The undersigned hereby certifies that the information contained on this application is true and correct and further agrees that any changes of ownership, officers or form in which the business operates shall be made known to Drake Ready Mix, Inc. in writing mail to by certified U.S. Mail, return receipt requested to: Drake Ready Mix, Inc., 2920 Rockfill Rd., Fort Myers, FL 33916, or set changes shall be ineffective as to Drake Ready Mix, Inc. of the terms of this agreement. This agreement contains the entire agreement between the parties and may not be modified or mended except by writing signed by both parties hereto. The singular herein shall include the plural, the masculine shall include the feminine and neuter gender, as context requires.

The undersigned, authorizes Drake Ready Mix, Inc. to seek credit information from credit bureaus, trade references, from our and other vendors, and banks; the undersigned authorizes them to release information based on a photocopy of this instrument.

Personal Guarantee: In consideration of extension of credit to the business entity of this application under the terms of sale shown above in the Credit/Sales Agreement, I, the undersigned fully guarantee and hold myself personally responsible for the payment at maturity of the purchase price of all such goods, product and merchandise sold or delivered whether evidenced by open account, acceptance, note or otherwise, including interest hereon. I hereby waive Notice of Acceptance hereof, amounts of sale, date of shipment or delivers, notice of default of payment and legal proceedings against the business entity.

This is intended to be construed to be, a continuing Guaranty applying to all sales made to the business entity, and shall not be revoked by death of the guarantor but shall remain in force until I or My executors or Administrators shall haven given notice in writing to make no further advances on the security of this Guaranty, such notice to be mailed to Drake Ready Mix, Inc., by certified U.S. Mail, return receipt requested.

It is understood that there is no limit to my liability under this Guaranty.

Should it become necessary to place this guaranty with an attorney or collection agency, suit or other legal action, I hereby agree to pay all costs of collection including, but not limited to, attorney fee equal to the greater of 33 1/3 of the monies due to Drake Ready Mix, Inc., or an attorney fee equal to the hourly fee charged by Drake Ready Mix, Inc. attorneys multiplied by the hours expended by the said attorneys. Attorney fees shall be paid by Guarantor when incurred for consultation, trial or appellate services, whether suit may be brought or not. The terms of this guaranty shall be governed by the laws of the state of Florida. Venue for settlement of any disputes arising under this guaranty, including litigation, regardless of place of payment, shall be in a forum or court as required, of competent jurisdiction in Lee County, Florida, and undersigned waives any venue rights he may possess and agrees that he shall not contest that Lee County, Florida, is a convenient forum. This Guaranty contains the entire agreement between the parties and may not be modified or amended except by writing signed by both parties herein. The singular herein shall include the plural, and masculine, shall include the feminine and neuter gender, as context requires.

Witness*

Owner/Officer Signature*

Date*

Date

Print Name*

First NameLast Name

Social Security Number*

Witness

Owner/Officer Signature

Date

Print Name

First NameLast Name

Social Security Number

Business Information

Disclaimer

Signatures