Credit Application
Contact Information
First Name
Last Name
Company Name
Phone Number
FAX Number
Company Address
Address Line 1
Address Line 2
City
State
Zip Code
Date Business Commenced
Business Type
Sole Proprietorship
Partnership
Corporation
Other
Business and Credit Information
Accounts Payable Contact
Billing Address
Address Line 1
Address Line 2
City
State
Zip Code
Phone Number
FAX Number
Email Address
Bank Name
Primary Business Address
Address Line 1
Address Line 2
City
State
Zip Code
Phone Number
Account Number
Type of Account
Savings
Checking
Other
Business/Trade References
Company Name
Address
Address Line 1
Address Line 2
City
State
Zip Code
Phone Number
FAX Number
Email Address
Type of Account
Savings
Checking
Other
Other
Company Name
Address
Address Line 1
Address Line 2
City
State
Zip Code
Phone Number
FAX Number
Email Address
Type of Account
Savings
Checking
Other
Other
Company Name
Address
Address Line 1
Address Line 2
City
State
Zip Code
Phone Number
FAX Number
Email Address
Type of Account
Savings
Checking
Other
Other
Agreement
All invoices are to be paid within the terms assigned to the account.
Claims from invoices must be made within seven working days.
By submitting this application, you authorize Bell Concrete, Inc. to make inquiries into the banking and business/trade reference that you have supplied.
Signatures
First Name
Last Name
Title
Date
Signature
Sign Here
First Name
Last Name
Title
Date
Signature
Sign Here
Submit Application
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Contact us Monday through Friday between 8:00AM and 5:00PM
453 Hillcrest Dr S.
Sulphur Springs, Tx 75482
903-885-3126
903-885-3128
Greenville
Sulphur Springs
Mt. Pleasant
Bell Concrete Inc.
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