For your convenience we have added a credit application to our site. All fields with red asterisk (*) are required to be filled in, so we can process your application in a timely matter.

Original must be printed, signed and mailed to:
755 Stockton Ave, San Jose, CA 95126

 

CREDIT APPLICATION & PURCHASE AGREEMENT

APPLICATION MUST BE FILLED OUT COMPLETELY. TO AVOID DELAY IN PROCESSING YOUR ORDERS, PLEASE RETURN TO OUR CREDIT MANAGER IMMEDIATELY. PLEASE TYPE OR PRINT CLEARLY.

NOTE: YOU MUST FILL OUT THE FIELDS WITH ( * )          Download a Printable Version PDF file
* Name:  

PHONE&FAX eg:  408-8951276

  
* Email: * Business Lic:

* Address: * Phone:

   Apt/Suite:      Fax:

 
* City:  

 
* Zip:  

 
       

EG: MM/DD/YYYY

  
* Contractor Lic: * Expiration Date:

Check One    

* IF LLC, ATTACH ARTICLES OF ORGANIZATION
 Proprietorship  Corporation  LLC *

 Partnership     Year Started:

 
Charge Sales Tax    

 

  
     

IF NO, ATTACH SIGNED RESALE CARD.

 Yes  No Resale #:

Has company or any of the principals filed bankruptcy?

 

  
     

IF YES WHAT

 
 Yes  No Chapter:

    Name of case:

Has the company or any officers or owners of the company ever had either a judgment or a state or federal tax lien filed against them personlly or against any business entity associated with the person?
     

IF YES WHERE, WHEN

 Yes  No Location:

    Date:

Incorporated or Partnership (List Officers Or Partners)  
 
President Or Sole Ownership  
* Name:  

PHONE eg:  408-8951276

  
* Address: * SSN:

* City: * Phone:

* Zip:  

 
       

Vice President  
* Name:  

PHONE  eg:  408-8951276

  
* Address: * SSN:

* City: * Phone:

* Zip:  

 
       

 
SEC./TREAS.  
* Name:  

PHONE  eg:  408-8951276

  
* Address: * SSN:

* City: * Phone:

* Zip:  

 
       

Give Four Credit References:

 

 
Reference 1:  
* Name:  

PHONE  eg:  408-8951276

  
* Address: * Phone:

* City:    Fax:

* Zip:  

 
       

 
Reference 2:  
* Name:  

PHONE  eg:  408-8951276

  
* Address: * Phone:

* City:   Fax:

 
* Zip:  

 
       

 
Reference 3:  
* Name:  

PHONE eg:  408-8951276

  
* Address: * Phone:

* City:    Fax:

 
* Zip:     

 
       

 
Reference 4:  
* Name:  

PHONE  eg:  408-8951276

  
* Address: * Phone:

* City:    Fax:

 
* Zip:     

 
       

 
Purchase Agreement

 

TERMS:
CONCRETE - $1.00 PER YARD- 10TH PROX. NET 30 DAYS

CLICK HERE FOR ADDITIONAL TERMS AND CONDITIONS

 
* Name of Company:  

* Signature: * Title:

* Signature: * Title:

      
GUARANTY

The undersigned hereby represents that he (she) has a financial interest in said business and on behalf of himself (herself) and his (her) marital community hereby agrees to the above terms and conditions and personally and unconditionally guarantees, jointly and severally, payment of said business' account. I (we) grant permission for Central to use consumer credit reports to determine my (our) credit worthiness as guarantor of the above account. It is understood that credit would not be extended without this assumption of liability and that this obligation and/or liability will continue until terminated in writing sent certified mail return receipt requested.
* Signature: * SSN#:

* Co-Guarantor: * SSN#:

     

© Copyright 2005. All Rights Reserved. Central Concrete.com .