Full Line Catalog Page 979 Geo And Environmental Solutions

credit application LEGAL NAME OF CUSTOMER: EMAIL ADDRESS: STREET ADDRESS: CITY STATE ZIP MAILING ADDRESS: CITY STATE ZIP COUNTY: BUSINESS PHONE: BUSINESS FAX: TYPE OF BUSINESS (check the ONE that best describes business): NO. OF EMPLOYEES: RESIDENTIAL CONTRACTOR GOVERNMENT COMMERCIAL CONTRACTOR NON CONTRACTOR/OTHER BUSINESS START DATE: RESELLER A/P CONTACT: A/P PHONE: A/P FAX: A/P EMAIL: PURCHASING CONTACT: PURCHASING PHONE: PURCHASING FAX: PURCHASING EMAIL: PURCHASE ORDER NO. REQUIRED? FED. TAX DUN & BRADSTREET ID NO.: NUMBER (DUNS #): NAME OF BRANCH FROM WHICH PURCHASES WILL BE MADE: PREDOMINANT TRADE (to be completed by Contractors ONLY, check the ONE that best describes business): DRYWALL FLAT WORK MECHANICAL/PLUMBING ROAD AND BRIDGE WATERPROOFING ELECTRICIANS FRAMING POURED WALL/FOUNDATION SPECIALTY TRADES MASONRY EXCAVATION GENERAL CONTRACTOR PRECAST TILT UP BUILDERS NAME: ADDRESS: ACCT #: PHONE: BANK NAME: ADDRESS: ACCT #: PHONE: GUARANTOR 1 DATE: SS NO: PRINTED NAME: SIGNATURE: HOME ADDRESS: PHONE NO.: GUARANTOR 2 DATE: SS NO: PRINTED NAME: SIGNATURE: HOME ADDRESS: PHONE NO.: AUTHORIZED SIGNATURE PRINTED NAME DATE v1.0 PLEASE SELECT ONE: SOLE PROPRIETORSHIP PARTNERSHIP CORPORATION NON PROFIT ORG. JOINT VENTURE L.L.C. YES NO ARE YOU SALES TAX EXEMPT? (AN EXEMPTION CERTIFICATION MUST BE ATTACHED) ESTIMATED MONTHLY PURCHASES $ ***FOR MAXIMUM CREDIT LIMIT, PLEASE ATTACH COPY OF MOST RECENT FINANCIAL STATEMENTS AND/OR BANK STATEMENT*** SELLER'S USE ONLY YES NO TRADE / BANK REFERENCES of Purchaser certifies that it is solvent and capable of meeting its obligations hereunder, and that all information provided to seller (including Purchaser's attached financial statement) is true, accurate and complete. All such information has been submitted for the purpose of obtaining credit. Purchaser and each Guarantor authorize HD Supply and/or its affiliates ("Seller") to request credit reports from credit bureaus (including consumer reporting agencies) regarding their respective commercial or personal credit and otherwise to investigate their respective creditworthiness before extending credit now or any time in the future. Purchaser also agrees to comply with the applicable bulk sales laws. Purchaser agrees that all Terms and Conditions of Sale on the reverse side this Credit Application and Personal Guaranty, as the same may be amended by written notice to Purchaser from time to time, shall apply to all sales and extensions of credit made to Purchaser by Seller. To induce the extension of credit to Purchaser, Guarantor (jointly and severally, if more than one) hereby guarantees payment of all existing and future indebtedness of Purchaser to Seller, including any costs, expenses, and reasonable attorney's fees payable as a consequence of Seller's collection efforts. This personal guaranty is absolute, complete, irrevocable and continuing and it shall not be necessary for Seller to give notice to Guarantor of any extension of credit to Purchaser, any renewal thereof, any modification of the terms thereof, or Seller's arrangements with any other Guarantor. Guarantor may by written notice to Seller at its Corporate Headquarters as described above (Attn: Credit Dept.) terminate its guarantee as to any new extensions of credit to Purchaser made more than ten (10) days after such written notice, but Guarantor shall continue to be obligated in respect of any credit extended within ten (10) days after Seller's receipt of such notice and any credit Seller remains obligated to extend to Purchaser at the close of business on the tenth day following Seller's receipt of such notice. Guarantor agrees to provide personal financial information as reasonable requested by Seller. PERSONAL GUARANTY (REQUIRED IF BUSINESS WAS ESTABLISHED WITHIN THE LAST THREE YEARS) TERMS AND CONDITIONS (AUTHORIZED SIGNATURE REQUIRED) CREDIT APPLICATION FAX: 866-791-4809 E-MAIL: creditapplications@whitecap.net PH: 888-888-6087, OPTION 3, OPTION 3, OPTION 1 BRANCH MANAGER: BRANCH NAME: BRANCH #: SALESMAN: SALESMAN ID: COMMENTS:

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