APPLICATION FOR OPEN ACCOUNT
The
undersigned hereby applies for an open account with C.R. 33 or C.R. 466A
LANDFILL FACILITY, LLC and submits the following information for this
purpose.
NAME
OF INDIVIDUAL OR FIRM_______________________________________________________
STREET
ADDRESS____________________________________________________________________
_____________________________________________________________________________________
BILLING
ADDDRESS__________________________________________________________________
_____________________________________________________________________________________
OFFICE
PHONE_______________________________
FAX NUMBER_________________________
TYPE
OF BUSINESS____________________________________ FEDERAL ID #_________________
APPLICANT
IS: SOLE PROP._______ PARTNERSHIP _______ CORP. _______ OTHER _______
NAME
OF OWNERS, PARTNERS OR CORPORATE OFFICERS
NAME____________________________ HOME
ADDRESS___________________________________
NAME____________________________ HOME
ADDRESS___________________________________
BANK
REFERENCE
NAME____________________________
ADDRESS__________________________________________
ACCOUNT
NO.____________________ CONTACT__________________________________________
VENDOR
REFERENCES
_______________________________________________________________________________________
NAME
ADDRESS CITY, STATE, ZIP FAX
NO. ONLY
_______________________________________________________________________________________
NAME
ADDRESS CITY, STATE, ZIP FAX
NO. ONLY
_______________________________________________________________________________________
NAME
ADDRESS CITY, STATE, ZIP FAX
NO. ONLY
OUR FIRM IS
FINANCIALLY ABLE TO MEET ANY COMMITMENTS WE MAY INCUR, AND WE EXPECT TO PAY INVOICES
ACCORDING TO YOUR TERMS OF NET 15 DAYS. WE UNDERSTAND 1.5% INTEREST PER
MONTH WILL BE CHARGED ON ALL PAST DUE BALANCES AND WILL BE ADDED TO OUR
ACCOUNT. SHOULD IT BECOME NECESSARY TO PLACE THIS ACCOUNT WITH AN ATTORNEY FOR
COLLECTION, SUIT OR OTHER LEGAL ACTION, I/WE HEREBY AGREE TO PAY ALL COSTS OF
SUCH COLLECTION, SUIT OR OTHER LEGAL ACTION, INCLUDING REASONABLE ATTORNEY’S
FEES. ALL SUCH ACTION WILL BE INSTITUTED IN LAKE COUNTY, FLORIDA. THE UNDERSIGNED AUTHORIZES THE REFERENCES
LISTED HEREIN ABOVE TO RELEASE CREDIT AND/OR ACCOUNT INFORMATION TO CR 33 OR CR
466A LANDFILL FACILITY, LLC.
Submitted
and agreed to
by________________________________________________________________
Title________________________________________________ Date____________________________
Fax completed application to: (352) 787-5199 Attn: Phyllis Cages
or mail to:
C.R. 33 Landfill Facility, LLC
or
C.R. 466A Landfill Facility, LLC
P.O. Box 490697
Leesburg, FL 34749-0697
* If your purchases are to be
tax exempt, please submit your Resale or Exemption Certificate.