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Waltham Lime & Cement Credit Application

Fields in marked in ORANGE are required.

    Applicant's Business Name
  
   Address
  
   City
   		State
Zip
   Business Phone
   		Amount of Credit Requested
   Type of Business
   		Date Established
   Type of Organization
Proprietorship   Partnership   Corporation   Trust
Other
   Principals
   1. Name
   		Title
Address
Home Phone
   2. Name
   		Title
Address
Home Phone
   Bank References
   1. Name of Bank
   		Address
Phone
   2. Name of Bank
   		Address
Phone
   Trade References
   1. Name of Company
   		Address
Phone
   2. Name of Company
   		Address
Phone
   3. Name of Company
   		Address
Phone
   4. Name of Company
   		Address
Phone
   How were you introduced to Waltham Lime & Cement Co., Inc?
Contacted by Salesperson  
Customer  Manufacturer Saw Our Truck   Advertisement   Yellow Pages  
Other  

I certify that the above statements are true and are made for the purpose of obtaining credit and in consideration of WALTHAM LIME & CEMENT CO., INC. selling to me or to my agent(s), I agree to the following terms:
  1. PAYMENT TERMS:
    Cash Discount indicated on each invoice may be taken if paid in full by 10th of each month following purchase. Net Amount is due on the 25th of the month following purchase.
  2. To pay a service charge for a late payment, computed at an annual percentage rate of 18% (periodic monthly rate of 11/2%) on all balances remaining unpaid 25 days after month of purchase.
  3. In the event that this debt is turned over to an attorney for collection, the corporation or partnership and the individual guarantors agree to pay an attorney's fee equal to one third of the balance of principal and interest and owing, plus all other costs and expenses of collections.
  4. To authorize WALTHAM LIME & CEMENT CO., INC. and/or any credit bureau or other investigative agency acting for WALTHAM LIME & CEMENT CO., INC. to investigate the information provided above.
Please provide your email address so that we may contact you if there is a problem/question regarding the on-line credit application submission.
Email Address:
Note: Your email address and other personal information will only be used for the purposes of the credit application and will not be shared with any third parties not involved in the credit application processing.



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