APPLICATION FOR CREDIT
ALLIANCE CONCRETE, INC.
PLEASE TYPE OR PRINT AND RETURN TO THE SALES COORDINATOR BY FAX OR EMAIL
Kallie Gorter, 712-541-9939, kgorter@gcc.com
APPLICANT INFORMATION
Business name: Phone: Cell: Fax:
Billing Address: Business Address:
City, State, Zip: City, State, Zip:
Federal ID or SSN: Accounts Payable Contact:
Tax Exempt Y N Certificate # Billing to be emailed Y N Email address:
Years in Business: Applicant is: mark one Corp - LLC - Partnership
Sole Proprietor - Homeowner
BANK INFORMATION
Bank Name: Contact:
Bank Address: Type of Account:
Phone: Fax: Account Number:
CREDIT REFERENCES
Company Name: Company Name:
Address: Address:
City, State, Zip: City, State, Zip:
Phone: Fax: Phone: Fax:
Account# Contact: Account# Contact:
 
Company Name: Company Name:
Address: Address:
City, State, Zip: City, State, Zip:
Phone: Fax: Phone: Fax:
Account# Contact: Account# Contact:
PRINCIPALS, OWNERS, OR OFFICERS
Name: Name:
Home Address: Home Address:
City, State, Zip: City, State, Zip:
SSN Title: SSN Title:
 
INTERNAL USE ONLY
ACCOUNT NUMBER: DATE
CODE NUMBER SALESMAN
APPROVED CATEGORY
 

 

 

GENERAL INFORMATION
Has your company ever previously applied for or received credit from GCC of America or any of its operating companies?
Have you or your company ever filed Bankruptcy: Yes
TERMS & CONDITIONS

In the event that GCC of America or any of its subsidiary or affiliated companies (herinafter, "GCC" or "Seller") offers extension of credit to the above named applicant (hereinafter, "Buyer") the following terms and conditions will apply:
*Except as otherwise provided by written agreement subsequently executed by both Buyer and Seller, these Terms and Conditions, and the terms in Seller's invoices shall supersede the terms and conditions of Buyer's order (including, without limitation, any statement that Buyer's terms or conditions are to take precedence over any contrary provisions), and no prior or subsequent understanding, oral representation, agreement, term, condition, or trade custom at variance with or supplemental to these Terms and Conditions shall be binding on the Seller.
*Any extension of credit is issued pursuant to the information and financial representations made herein by said credit applicant and/or said guarantors.
*A faxed application will be deemed as the original.
*ALL accounts are due IN FULL by the 30th of the month following the month of purchase.  Any such amounts not paid when due shall become deliquent and shall bear interest at the rate of one point two-five percent (1%) per month, or an annual percentage rate of 12%
*GCC may decline further credit purchases if any portion of the account is past due.
*Any returned checks may be assessed a $30 processing fee (or the maximum allowed by law in the state of acceptance).
*The privilege of making credit purchases will be terminated if there is any change in the applicant's ownership, management, or form of business organization unless GCC is notified and agrees to such change.
*Any amounts paid under the agreement by the above named applicant to GCC may be applied by GCC to outstanding principal and interest as GCC deems appropriate.
*Customer is responsible for all collection costs, legal fees and attorney's fees if payment is not received pursuant to these Terms and Conditions.
*Accounts will be goverened by Iowa Law and proper venue will be Sioux County, Sioux Center, Iowa

THE UNDERSIGNED CERTIFIES THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND CORRECT AND AUTHORIZES GCC AND ANY CREDIT BUREAU OR INVESTIGATIVE AGENCY TO INVESTIGATE THE INFORMATION CONTAINED WITHIN THIS APPLICATION AND OBTAIN INFORMATION ABOUT THE UNDERSIGNED'S ACCOUNTS AND CREDIT EXPERIENCE.  THE UNDERSIGNED AUTHORIZES ALL PARTIES CONTACTED TO RELEASE CREDIT AND FINANCIAL INFORMATION REQUESTED AS A PART OF SAID INVESTIGATION. GCC MAY ALSO DISCLOSE INFORMATION ABOUT THE UNDERSIGNED TO OTHER LENDERS AND CREDIT BUREAUS.  THE APPLICANT FURTHER AUTHORIZES GCC TO REINVESTIGATE THEIR CREDIT STATUS FROM TIME TO TIME AS GCC DEEMS NECESSARY.  GCC, UPON SUCH REINVESTIGATION, MAY LIMIT OR TERMINATE THE CREDIT ARRANGEMENT WITH THE ABOVE NAMED APPLICANT UPON WRITTEN NOTICE TO APPLICANT.

Your signature certifies the information entered on this entire document as true and correct and that the applicant has read and understood all of theTerms and Conditions above.

By: (Printed Name)_____________________________________________ Title:_____________________________________________

Authorized Signature:____________________________________________ Date:__________________________

GUARANTORS

In consideration of any extension of credit by GCC of America or any of its subsidiary or affiliated companies (hereinafter, "GCC") either now or in the future to the above named applicant, on the above terms or any other terms agreed to between said applicant and GCC, the undersigned, unconditionally, personally jointly and severally guarantee the payment of any and all sums due or which may become due as a result of any such extension of credit. This guaranty shall remain in full force and effect and otherwise valid and binding until such time as the undersigned gives GCC written notice by certified mail that this guaranty is revoked and GCC should make no further extentions of credit on the security of this guaranty. If GCC has to initiate legal proceedings to enforce this guaranty, then you agree to pay GCC's reasonable attorney's fees for enforcing this guaranty.

Further, the undersigned hereby authorize GCC to contact any credit reporting agency or any other credit references for the purpose of obtaining a consumer credit report for the purpose of evaluating creditworthiness in connection with this application for business credit and guarantee of payment.

Printed Legal Name: Printed Legal Name:
Social Security Number: Social Security Number:
Signature:_______________________________________ Signature:________________________________________
Printed Legal Name: Printed Legal Name:
Social Security Number: Social Security Number:
Signature:______________________________________ Signature:________________________________________