Business Application Form

Business Application Form

Become a customer of HC Mining
Do you need credit terms, or will you pay at the point of sale (POS)?
Authorized Person Information
Authorized Person - Name

PrefixFirst NameLast Name
Authorized Person - Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Authorized Person - Email
example@example.com
Authorized Person - Title/Position
Authorized Person - Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Information
Company Info - Company Name
Company Info - Company Email
example@example.com
Company Info - Phone Number
Company Info - Tax I.D. Number
Company Info - Company Website
Company Info - Type of Business
Company Info - In Business Since :

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Company Info - Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Bank References
Bank References - Institution Name
Bank References - Checking Account #
Bank References - Contact Person

First NameLast Name
Bank References - Contact Person Phone Number
Format: (000) 000-0000.
Bank References - Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Bank References - Institution Name 2
Bank References - Checking Account # 2
Bank References - Contact Person 2

First NameLast Name
Bank References - Contact Person Phone Number 2
Format: (000) 000-0000.
Bank References - Address 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Trade References
Trade References - Company Name
Trade References - Contact Name

First NameLast Name
Trade References - Phone Number
Format: (000) 000-0000.
Trade References - Account opened since

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Trade References - Current Balance
Trade References - Credit Limit
Trade References - Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
2nd Trade References - Company Name
2nd Trade References - Contact Name

First NameLast Name
2nd Trade References - Phone Number
Format: (000) 000-0000.
2nd Trade References - Account opened since

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
2nd Trade References - Credit Limit
2nd Trade References - Current Balance
2nd Trade References - Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Financial Information
Tax Exempt
Financial Information - Company Total Assets
Financial Information - Annual Net İncome
Financial Information - Amount of Credit Requested
Financial Information - Have you or your officers or affilates ever filed a petition in bancruptcy?
If so, describe
Financial Information - Is your company subject to any litigation?
If so, describe
TERMS & CONDITIONS
HC Mining, LLC Terms and Conditions apply to all orders. See https://www.hcminingllc.com/terms or call (972) 474 6302 for a copy. If the project is not completed by the REBID/WITHDRAW DATE, HC Mining, LLC may rebid or withdraw. Pricing depends on material availability.
Signature

By signing this you are agreeing to the HC MINING, LLC TERMS AND CONDITIONS OF SALE
Notes
Status
Price List
Payment Terms
Should be Empty:

Business Application Form

Authorized Person Information

Company Information

Bank References

Trade References

Financial Information

TERMS & CONDITIONS