Credit Application for a Business Account

If you are a customer of Mid Atlantic Concrete Equipment and would like to set up a credit account, please fill out the form below and either submit it electronically by clicking the "APPLY" button at the bottom, or print it out and fax it to us at 888-378-6223.

BUSINESS CONTACT INFORMATION
Title:
Company Name:
Phone:
Fax:
Email:
Registered Company Address
  Street Address:
  City:
  State: Zip Code:
Date Business Commenced:
Sole proprietorship  Partnership  Corporation
Other - Specify

BUSINESS AND CREDIT INFORMATION
Primary business address
  Street Address:
  City:
  State: Zip Code:
How long at current address?
Phone:
Fax:
Email:
Bank Name: Phone:
Bank Address
  Street Address:
  City:
  State: Zip Code:
Type of accountAccount number
  Savings
  Checking
  Other

BUSINESS/TRADE REFERENCES
Company Name:
Street Address:
City:
State: Zip Code:
Phone: Fax:
Email:
Type of Account:
Company Name:
Street Address:
City:
State: Zip Code:
Phone: Fax:
Email:
Type of Account:
Company Name:
Street Address:
City:
State: Zip Code:
Phone: Fax:
Email:
Type of Account:

AGREEMENT

1. All invoices are to be paid 30 days from the date of the invoice.

2. Claims arising from invoices must be made within seven working days.

3. By submitting this application, you authorize Mid Atlantic Concrete Equipment, Inc. to make inquiries into the banking and business/trade references that you have supplied.


CONFIRM
Your Name:
Email: