COMMERCIAL CREDIT APPLICATION

P.O. Box 13527
Roanoke VA 24035
Tel: (540) 777-7600
Fax: (540) 777-2064
COMMERCIAL CREDIT APPLICATION
APPLICANT:
_______________________________________________________________________________________________
MAILING ADDRESS:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
STREET ADDRESS:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
CONTACT PERSON:
TELEPHONE:
FAX:
PARTNERSHIP
CORPORATION
E-MAIL:
PROPRIETORSHIP
LLC
OTHER
YEAR BUSINESS STARTED
STATE OF ORIGIN
TAX ID# (COMPANY, PARTNERSHIP, ETC OR SOCIAL SECURITY NO)
INFORMATION ON PRINCIPALS
LIST ALL OWNERS/PARTNERS FOR PROPRIETORSHIP OR PARTNERSHIP
LIST ALL OFFICERS/MEMBERS FOR CORPORATION OR LIMITED LIABILITY COMPANY
NAME
ADDRESS
TITLE
PHONE
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
ANSWER THE FOLLOWING FOR THE APPLICANT AND ALL ITS OWNERS, PARTNERS, OFFICERS AND MEMBERS:
1) HAVE YOU FILED FOR BANKRUPTCY?
YES
NO
IF YES, GIVE DATE
2) ARE THERE ANY OUTSTANDING JUDGMENTS OR LIENS?
YES
NO
3) ARE THERE ANY LEGAL ACTIONS OR ARBITRATIONS PENDING?
YES
NO
BANK REFERENCE
NAME:
CONTACT NAME:
ADDRESS:
TELEPHONE:
TRADE REFERENCE
NAME:
CONTACT NAME:
ADDRESS:
TELEPHONE:
NAME:
CONTACT NAME:
ADDRESS:
TELEPHONE:
NAME:
CONTACT NAME:
ADDRESS:
TAX STATUS
TELEPHONE:
TAXABLE
NON-TAXABLE
TAX EXEMPTION NO:
DO YOU REQUIRE PURCHASE ORDER NUMBERS ON YOUR INVOICES?
YES
(INCLUDE CERTIFICATE)
NO
NOTE: IF YOU ISSUE WRITTEN PURCHASE ORDERS, THEY MUST BE APPROVED AND SIGNED PRIOR TO ANY SHIPMENTS.
2014 05 VERSION
PAGE 1 OF 2
TERMS AND CONDITIONS
The undersigned ("Applicant") hereby makes application for credit from one or more of the Boxley companies and/or their affiliates, including Boxley
Materials Company, Boxley Concrete Products of VA, Inc., Boxley Trucking Company, Inc., Boxley Aggregates of West Virginia, L. H. Sawyer Paving
Company, Inc., L.L.C., Boxley Asphalt, LLC and Boxley Block, L.L.C. (collectively referred to herein as "Boxley"). In this connection Applicant hereby
authorizes and requests each trade or bank reference listed herein to advise Boxley of its credit experience with and to express an opinion as to the credit
record of Applicant. Applicant acknowledges and agrees that Boxley in its sole discretion may submit this Commercial Credit Application and other credit
information to others, including other potential sources of the credit sought by this application, as well as Boxley's successors and assigns. Further,
Applicant, and each person signing below on behalf of Applicant agree that Boxley may obtain personal credit reports with respect to Applicant's officers,
partners and owners. Applicant acknowledges that Boxley may, in its sole discretion, refuse to extend credit to Applicant in connection with any credit
transaction. If credit is extended, Applicant agrees to pay invoices in accordance with the following payment terms and further agrees to pay costs of
collection, including a minimum of 25% attorneys' fee.
Terms: Payment is due on all invoices 30 days from invoice date. A service charge shall be added to all past due statements at 1½% per month (annual
percentage rate (APR) of 18%). The service charge will accrue on past due balances. In no event shall a service charge exceed the highest rate
permitted by law, and any excess service charge shall be returned or credited to Applicant's account. Payments will be applied first to unpaid service
charges. The undersigned agrees to pay service charges and any additional collection costs, including attorneys' fees, in the event collection action is
necessary.
Venue and Jurisdiction: Applicant hereby submits to the jurisdiction and venue in a Court of competent jurisdiction in the County of Roanoke, Virginia,
or the County of Bedford, Virginia for any legal action, and agrees (subject to the provisions of the next paragraph) that these Courts shall be the exclusive
Courts in which actions may be brought by Boxley or Applicant with regard to any extensions of credit and/or to any goods sold or supplied to Applicant.
The laws of the Commonwealth of Virginia shall apply to actions brought in Virginia Courts.
For goods and materials sold in and/or delivered to projects or sites located in West Virginia, Boxley, at its option, may bring an action against Applicant
for payment of such goods and materials in a Court of competent jurisdiction in Kanawha County, West Virginia, in which event Applicant agrees to
submit to that court' s jurisdiction and venue for such legal action. The laws of the State of West Virginia shall apply to such proceedings brought in West
Virginia.
Extension of Credit: The amount of credit that Boxley extends to Applicant is subject to change or limitation at any time, either before or after delivery of
any part thereof, of an order. Payment in advance may be required as a precedent to delivery or provisions of services. If Applicant's account is in
arrears, Boxley shall have the right, in addition to all other legal remedies and without prejudice to any other or Boxley's rights, to defer further shipments
or services until payment is received. Not withstanding prior extensions of credit, prepayment may be required prior to any subsequent delivery of goods
or services.
If Applicant requests a specific credit limit, Applicant hereby agrees that Applicant will be liable for any amounts that exceed said specified credit limit,
and Applicant hereby waives notice that it has exceeded its credit limit. Applicant further agrees that Boxley may increase Applicant's credit limit
without prior notice to Applicant, and Applicant agrees to be bound by such credit limit increase unless and until it notifies Boxley in writing to reduce
said credit limit.
If Applicant merges with, forms, creates or becomes a corporation, limited liability company, partnership, limited partnership or other entity, with or without
Boxley's knowledge, Applicant shall nevertheless remain obligated hereunder and shall remain fully liable for any indebtedness assigned to, transferred to
or assumed by such entity, in whole or in part.
Applicant hereby warrants that the information contained in this credit application is true to the best of my/our knowledge. Applicant and all guarantors
hereby authorize Boxley to check all credit references and information provided and to utilize all other credit resources deemed necessary to determine
my/our creditworthiness. Applicant further authorizes Boxley to obtain any additional information necessary to approve the extension of credit to Applicant
or Applicant's business.
Applicant hereby agrees to promptly advise Boxley of any material changes in the information or responses given in this Application for credit. Applicant
hereby agrees to immediately notify Boxley of any change of ownership or address or form of business.
Applicant hereby represents that none of the credit extended by Boxley to Applicant is being used in connection with the purchase of goods or services
for personal, family or household purposes but is an extension of credit for business or commercial purposes.
For goods sold by Boxley to Applicant, Applicant hereby gives Boxley a purchase money security interest in those goods and their proceeds. Applicant
hereby agrees to execute any documents that are necessary for Boxley to perfect its security interest in goods sold by Boxley, and Applicant hereby
appoints Boxley as its attorney-in-fact for the limited purpose of executing such documents.
The failure of Boxley to insist on strict performance of any term, covenant or condition contained in this application shall not be construed as a waiver of
such term, covenant or condition in any other instance.
Applicant's Certification and Agreement
Applicant and each person signing below on behalf of Applicant represents that the information contained in the application is true and correct.
All the above information is complete, correct and provided to Boxley to obtain credit. I authorize Boxley to investigate credit and employment history and
to report the credit experience of any party or authorized user to business reporting agencies and others. I understand that you may retain this application
whether or not it is approved.
_________________________________________________
Authorized Signature
_________________________________________________
Print Name
(Application must be signed for processing. Additional information may be required.)
2014 05 VERSION
_____________________________
Title
_____________________________
Date
Print Form
PAGE 2 OF 2
RESIDENTIAL PROJECT INFORMATION
Date
________________
Completion Date
___________________
Customer
__________________________________________
Project
________________________________
Physical Address
___________________________________________________________________________
___________________________________________________________________________
Lot Number
_______________
Subdivision ____________________________________________
Building Permit No
__________________________
Description as shown on building permit
___________________________________________________________________________________________
___________________________________________________________________________________________
Are you the prime contractor
YES ____
NO ____
If you are sub-contractor complete the following:
Prime Contractor
___________________________________________________________________________
Address
___________________________________________________________________________
Contact
____________________________
Spec House
Custom House
Owner Name
___________________________________________________________________________
Owner Address
___________________________________________________________________________
Owner Phone
____________________________
Financing provided by
_________________________________________________________________________
Contact
____________________________
Phone
__________________________________
If custom complete Owner Information
Phone
__________________________________
Mechanic’s Lien Agent
_______________________________________________________________________
Address
_______________________________________________________________________
_______________________________________________________________________
Contact
________________________ Phone
Return completed form to address below or fax to 540-777-2064
Boxley
Credit Department
P O Box 13527
Roanoke, VA 24035
2014 05
_________________________________
PRINT
COMMERCIAL PROJECT INFORMATION
Date
________________
Completion Date
___________________
Customer
__________________________________________
Project
________________________________
Physical Address
___________________________________________________________________________
___________________________________________________________________________
Are you the prime contractor
YES ____
NO ____
If you are sub-contractor complete the following:
Prime Contractor
___________________________________________________________________________
Address
___________________________________________________________________________
Contact
____________________________
Owner Name
___________________________________________________________________________
Owner Address
___________________________________________________________________________
Owner Phone
____________________________
Financing provided by
_________________________________________________________________________
Contact
____________________________
Phone
Phone
__________________________________
__________________________________
Payment Bond Information
Bonding Company
_______________________________________________________________________
Address
_______________________________________________________________________
Bond Number
_______________________________________________________________________
Contact
________________________
Phone
Return completed form to address below or fax to 540-777-2064
Boxley
Credit Department
P O Box 13527
Roanoke, VA 24035
2014 05
_________________________________
PRINT