Oconee Waste Transport
Confidential Credit Application/Contract
Please Complete In Full

1750 Greensboro Highway
Watkinsville, GA. 30677
(706) 769-1700Date Submitted
(706) 769-1333 Fax

We hereby apply for the extension of credit by your firm.  The following information is submitted as a basis for your consideration of our application.

Name of Firm or Individual

Address

Mailing Address (if different)

PhoneFax

Established in year
         
Type of Business (please specify in detail)

Purchase Order Required?

Name of Person Making Application

Principal Owners or Stockholders:
                   NameAddressPhoneTitleSocial Security Number








We expect our monthly credit requirements to be approximately $

Bank Reference

Address and Phone

Have you ever taken bankruptcy?                             If yes, when?

Principal Suppliers (Please List at Least Three)

                       NameAddress            Phone & Fax            Contact








Address & Phone of Home Office

Our Terms are Net 10th of the Month.  Statements are Mailed out on the 25th of every month and are expected to be paid in full by the 10th of the following month.  Any accounts not paid by the 10th of the month will be subject to a 1.5% late fee.

We certify that all information on this form is correct.  We fully understand your credit terms and agree to the proper payment in consideration of extended credit.

Electronic SignatureTitle

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Credit Application
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