ROOF CURB SYSTEMS, LLC APPLICATION FOR CREDIT
PO BOX 4538
CHATTANOOGA, TN 37405
(800) 683-5848 FAX:(800) 683-5849 AMOUNT OF CREDIT REQUESTED:________________
COMPANY NAME___________________________________________ FAX (____)________________
BILLING ADDRESS____________________________________________________________________
CITY____________________________STATE_______ZIP___________PHONE(____)_____________
HOME OFFICE ADDRESS______________________________________________________________
CITY_______________________STATE_______ZIP_____________PHONE(_____)_______________
TYPE OF BUSINESS_________________DATE BUSINESS ESTABLISHED_____/______/______AS
_____INDIVIDUAL ____ PARTNERSHIP _____LIMITED PARTNERSHIP ______CORPORATION
OFFICERS/ OWNERS NAMES TITLES ADDRESS PHONE NO.
__________________________ _____________ ______________________________ ____________
__________________________ _____________ ______________________________ ____________
__________________________ _____________ ______________________________ ____________
__________________________ _____________ ______________________________ ____________
ARE YOU SALES and/or USE TAX EXEMPT? ____YES ____ NO
IF YES, PLEASE ENCLOSE A COPY FOR OUR RECORDS.
ANY RESTRICTIONS ON PERSON(S) WHO CAN ACT AS AN AGENT FOR YOUR FIRM?________
_____________________________________________________________________________________
ACCOUNTS PAYABLE CONTACT - NAME______________________PHONE(___)_______________
BUSINESS PROPERTY IS ____OWNED ___LEASED- LEASED FROM ________________________
ADDRESS__________________________________CITY________________STATE____ZIP________
CONTACT________________________________PHONE(____)________________________________
BANK NAME__________________________________________PHONE(____)___________________
ADDRESS____________________________CITY____________________STATE_____ZIP_________
OFFICER HANDLING___________________________________PHONE(____)___________________
CHECKING ACCOUNT NO________________ SAVINGS ACCT. NO_____________OTHER_______
PLEASE SUPPLY REFERENCES WITH ACCOUNTS SET UP EQUAL TO (OR MORE THAN) THE
AMOUNT OF CREDIT REQUESTED
CREDIT REFERENCE ADDRESS CONTACT PHONE NO
1._____________________ __________________________ _______________ __________________
2._____________________ __________________________ _______________ __________________
3._____________________ __________________________ _______________ __________________
4._____________________ __________________________ _______________ __________________
IF AVAILABLE, PLEASE ATTACH COPY OF YOUR DUN & BRADSTREET (OR OTHER)
CREDIT REPORT.
_____________________________________________________________________________________
The undersigned applicant does hereby certify that the information given is correct and complete and agrees to
permit Roof Curb Systems, LLC to use this information for obtaining credit information. If, after checking the
above information, this applicant is approved, it is agreed and understood by Roof Curb Systems, LLC and the
Undersigned that all purchases made will be PAID IN FULL within 30 days from invoice date.
DATE ___/____/_____ COMPANY NAME_______________________________________________
BY____________________________________________ TITLE_______________________________
(AUTHORIZED SIGNATURE)
Forms | Specification Form | MBC-3 Lay Under Roof Curbs | Credit Application