Redland Disposal Account Credit Application

Redland Disposal Account Credit Application

Complete this credit application using the closest matching labels and groupings from the original PDF. Fields are optional unless clearly marked required in the source document.
Business Information
Legal Business Name
DBA / Trade Name
Billing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City / State / ZIP
Main Phone
Please enter a valid phone number.Format: (000) 000-0000.
Federal Tax ID (EIN)
Accounts Payable Contact
AP Email / Phone
Invoice Email
example@example.com
Business Type

Other
Business Type - Other
Project / Job Name
Project Location
Contractor / Customer PO #
Disposal / Project Details
Material(s) to be Disposed

Other
Material(s) to be Disposed - Other
Estimated Quantity
Estimated Loads Per Day
Estimated Project Duration
Hauling Company / Companies
Requested Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Trade References
Trade Reference 1 - Company
Trade Reference 1 - Contact
Trade Reference 1 - Phone / Email
Trade Reference 1 - Account / Terms
Trade Reference 2 - Company
Trade Reference 2 - Contact
Trade Reference 2 - Phone / Email
Trade Reference 2 - Account / Terms
Trade Reference 3 - Company
Trade Reference 3 - Contact
Trade Reference 3 - Phone / Email
Trade Reference 3 - Account / Terms
Requested Credit Terms
Requested Terms
Requested Terms - Other
Requested Credit Limit ($)
Preferred Invoice Method

Other
Preferred Invoice Method - Other
By signing below, I acknowledge and agree to the disposal fee listed above and all terms and conditions of this application. I understand and agree that:
- All loads delivered under my company’s account, including loads delivered by third-party haulers on our behalf, are our responsibility.
- Redland’s scale tickets, load tickets, and/or site records will be used to determine billable quantities.
- Only materials approved by The Redland Company may be delivered to the site.
- We are responsible for any additional costs associated with rejected, contaminated, misrepresented, prohibited, or otherwise unacceptable material delivered under our account.
- Invoices will be paid according to the approved payment terms.
- The Redland Company may suspend disposal privileges for past-due balances or accounts exceeding their approved credit limit.
- Disposal rates may be changed with advance written notice.
- We are responsible for reasonable collection costs and attorney’s fees associated with unpaid balances, to the extent permitted by law.
- We certify that all material delivered is accurately described and meets the site’s material acceptance requirements.
Applicant Authorization
Authorized Name / Title
Signature
Signature Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Internal Use / Approval Section
Approved Material(s)
Disposal / Tipping Fee Amount ($)
Disposal / Tipping Fee Unit
Approved Credit Limit ($)
Approved Terms

Other
Approved Terms - Other
Approved By
Effective Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
W9

Cancelof
Certificate of Insurance

The Redland Company, Inc. must be listed as the Certificate Holder and named as an Additional Insured, in accordance with the attached sample COI.

Please ensure the certificate and required endorsements match the insurance requirements shown on the sample.

Once completed, please email the COI and applicable Additional Insured endorsements back to us.
Should be Empty:

Redland Disposal Account Credit Application

Business Information

Disposal / Project Details

Trade References

Requested Credit Terms

Applicant Authorization

Internal Use / Approval Section