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Twin Cities Ready Mix, Inc.
Credit Application
Ph. (918) 438-8888   Fax (918) 438-8853


Credit Applied For  Plant Location  TIN/SSN 
Legal Business Name  
Street Address  Phone No. 
Mailing Address  Fax No. 
City  State  Zip Code  Cell No. 
E-Mail Address  Website 
Type of Business Corporate Partnership Sole Proprietorship
Year Established  Nature of Business 
Names of Officers or Owners of Firm, Title, and Social Security Numbers:



Bank Affiliation  Bank Officer 
Address  Phone No.  Fax No. 
Checking Account No.  Savings Account No. 
Are Purchase Orders Required?YesNo   Are Purchases Taxable?YesNo
Names of Authorized Buyers on this account:
  
  
  
Have you filed bankruptcy in the past seven years? YesNo  
If yes, what year? 
Business References: (business name, address, phone, and fax)
1. 2. 3. 
          
          
          
        


I, the undersigned, am an officer of this company and authorized to sign this application for 
credit.I understand that if credit is approved my signature enters the company into a binding 
agreement to the terms of credit set forth and guarantees payment of this account. I acknowldge
that purchases made on this account are due the first (1st) day of the month following purchase 
and past due after the tenth (10th) of the month following purchase; finance fees will be charged
after due date at a rate of .833% per month or 10% per annum. I understand that failure to make 
payment within the terms set forth will result in legal action and that all costs and fees 
resulting through effort to collect monies will be the responsibility of my company. I , the 
undersigned, also give my permission for Twin Cities to obtain the credit reports necessary to 
establish credit worthiness.

Signed By___________________________________Date_______________