Business Credit Application

Company Information

Name

First Name

Last Name

Email Address

Phone Number

(###)

###

####

Title

Name of Business

Tax I.D. Number

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Type of Business

In Business Since

Legal Form Under Which Business Operates

If Division/Subsidiary, Name of Parent Company

Include how long it has been in business

Company Principal #1

Include Name of Company Principal Responsible for Business Transactions, Title, Address, City, State, ZIP, and Phone Information

Company Principal #2

Include Name of Company Principal Responsible for Business Transactions, Title, Address, City, State, ZIP, and Phone Information

Bank References

Institution #1 - Checking Account

Include Name, Checking Account #, Address, and Phone Information

Institution #2 - Savings Account

Include Name, Savings Account #, Address, and Phone Information

Institution #3 - Home Equity Loan

Include Name, Home Equity Loan, Loan Balance, Address, and Phone Information

Trade References

Reference #1

Include Company Name, Contact Name, Address, Phone, Account's Open Date, Credit Limit, and Current Balance

Reference #2

Include Company Name, Contact Name, Address, Phone, Account's Open Date, Credit Limit, and Current Balance

Reference #3

Include Company Name, Contact Name, Address, Phone, Account's Open Date, Credit Limit, and Current Balance

Certification

I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions (Net 30-Day terms) of the credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein. I authorize Metro Dumpsters, LLC to investigate the references pertinent to my credit worthiness. I agree to abide by all of the terms and conditions of the Metro Dumpsters, LLC Credit Account Agreement, which are Net 30-Day terms, and a 1.5% interest charge on all accounts that exceed those Net 30-Day terms. I agree to pay all reasonable collection and attorney fees in the event Metro Dumpsters, LLC deems such action necessary. All Civil actions filed as a result of disputes arising out of this agreement shall be filed in the court of proper jurisdiction in Jackson County, Missouri.

Name

First Name

Last Name

Title

Date

YYYY