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Tidewater Block, LLC

Office:   (757) 539-1576  ---   Toll Free (800) 296-2562
                                   Fax:  (757) 934-2717
                         P.O. Box 1546 --- 999 Kenyon Road
                                                                                                Suffolk, Virginia  23439

 

CREDIT APPLICATION         


 

 

                               

                                Firm Name______________________________________________________________

Type of business__________________________________________________________

Street______________________________________P.O. Box_____________________

City______________________ State___________________ Zip___________________

Years in Business_________ Phone____________________ Fax___________________

Corporation__________________ Partnership_______________

Limited Partnership____________ Proprietorship____________

Are you tax exempt____________? If yes, attach certificate.

Do you require a purchase order?__________

If Corporation give Registered Agent__________________________________________

Address_________________________________________________________________

                                                                                                                                               

 

PRINCIPAL OWNERS AND STOCKHOLDERS

                 Name                 Address                                                                                 Title                            SSN

                                                                                                                                                                                     

                                                                                                                                                                                   

                                                                                                                                                                                   

                                                                                                                                                                                   

 

SUPPLIERS AND BANKS

                Name             Phone Number       FAX Number       Address                                                        Acct Number

                                                                                                                                                                               

                                                                                                                                                                               

                                                                                                                                                                                  

                                                                                                                                                                               

 

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TERMS AND CONDITIONS OF PAYMENT

Applicant warrants that all information contained in this application is true and complete. Applicant hereby authorizes Tidewater Block, LLC (Tidewater) or any credit bureau or other investigative agency employed by it to investigate references, statements and other date submitted herein pertaining to Applicantís credit and financial responsibility. Applicant agrees that purchases and/or deliveries may be authorized or accepted by Applicant without signature.

Tidewater issues a monthly statement on the 30th of each month. All invoices are payable by the 10th of the month following purchase.

Applicant hereby jointly and severally agrees to all of the foregoing terms:

______________________________ ______________

Name of Applicant Date

PERSONAL GUARANTY

We, the undersigned, for value receive and order to induce Tidewater Block, LLC to continue to sell and/or to commence selling material _______________________, its affiliates, or assigns (hereinafter collectively referred to as CUSTOMER), do hereby jointly and severally unconditionally guarantee and obligate ourselves to pay all debts and obligations heretofore or hereafter incurred by CUSTOMER on account of Tidewater Block sales to CUSTOMER from time to time, whether such sales were in the past or are in the future.

This Guarantee shall remain in full force and effect until same is terminated in writing and such termination is received by Tidewater at its above address. However, such termination shall not affect our liability under this GUARANTEE for CUSTOMERíS debts and obligations or orders placed by CUSTOMER prior to the date of Tidewater receipt and said termination of this GUARANTEE.

We hereby WAIVE: (1) Notice of the dates and amounts of CUSTOMERSí orders and purchases; (2) Notice of CUSTOMERíS default in paying for same; and (3) Our Homestead exemption benefits that may apply to our obligation herein.

We further agree that no extension of time for payment or a release of any person, firm or corporation from liability hereunder shall affect our joint, several, unconditional and continuing obligations to Tidewater.

We further agree that in the event that the CUSTOMERíS accounts become delinquent as stated above in the terms and condition of payment clause and collection of same is placed with attorney, we will hereby obligate ourselves, jointly and severally, to pay an attorneyís fee of 25% of the amount due on CUSTOMERíS account, plus interest (2% per month unless otherwise stated) and costs of collection.

Guarantor_________________________ Date___________

Address__________________________