Untitled Document

Concrete Ready Mix Inc.
33 Hillsdale Avenue, San Jose, California 95136
PO Box 50006, San Jose, California 95150-0006
Tel. (408) 224-2452 FAX (408) 224-3014

Credit Application

Company Information
Company Name:
Street Address:
Mailing Address:
City, State Zip:
Business Phone:		FAX:
Resale Permit:	Yes No	State/Number:
Certificate Attached:	Yes No	State/Number:

Contractors License:		State of Issue:
Classification:		Issue Date:		Expires:

Personal Information
Name (F-M-L):
Street Address:
Mailing Address:
City, State Zip:
Home Phone:
Drivers License #:
Social Security #:

Corporate Information
Business Type:	Sole Owner: Partnership Corporation:
Owner/Partner/Pres:
Partner/Vice Pres.
Partner/Secretary

Banking Information
Bank Name:
Branch:
Mailing Address:
City, State Zip:

Account #:		Checking: Savings:
Account #:		Checking: Savings:
Account #:		Checking: Savings:

Credit References
Name #1:
Street Address:
Mailing Address:
City, State Zip:
Phone Number:		FAX:
Name #2:
Street Address:
Mailing Address:
City, State Zip:
Phone Number:		FAX:
Name #3:
Street Address:
Mailing Address:
City, State Zip:
Phone Number:		FAX:
Name #4:
Street Address:
Mailing Address:
City, State Zip:
Phone Number:		FAX:

Terms of Credit:

A Finance Charge of 18% per annum or fraction thereof will be applied to all past due sums.
A Service Charge of $25 will be paid for each check returned unpaid
Customers will be rebilled for any discounts shaken after the discount date or obtained by checks which are later returned unpaid.

This application is to obtain credit from the named company whether purchases are to be made now or hereafter. In the event any part or all of any sum owing from the undersigned to the named company becomes past due, or in the event any term of credit or purchase has not been met as agreed, any part or all sums owing to the company shall thereupon become due and payable in full. The undersigned agrees to pay all reasonable costs, expenses, and attorney's fees pertaining to said sums.

Signature:	_____________________________________________________________
Title:		Date: