APPLICATION FOR OPEN ACCOUNT

 

The undersigned hereby applies for an open account with 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 C.R. 466A LANDFILL FACILITY, LLC.

 

Submitted and agreed to by________________________________________________________________

 

Title________________________________________________     Date____________________________

 

Please fax completed application to:    352-787-5199   Attn: Credit Department        

 

or mail to:                                      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.