Credit Application

Apply for a credit account with Center Redi-Mix. Complete the form below and our credit team will review your application. Most applications are processed within 1-3 business days.

Business Information

Business / Company Name*

DBA / Trade Name

Business Type*

Federal Tax ID / EIN

Year Established

Primary Business Trade / Industry

Billing Address

Street*

City*

State*

Zip*

Job Site / Shipping Address

Same as billing address

Street

City

State

Zip

Contact Information

Primary Contact Name*

Title

Phone*

Email*

Accounts Payable (optional)

AP Contact Name

AP Email

AP Phone

Credit Details

Amount of Credit Requested ($)

Is a Purchase Order Required?

Tax Exempt?

Remarks / Description of typical projects

Bank Reference

Bank Name

Bank Contact

Bank Phone

Bank City / State

Trade References

Provide up to 3 trade references from companies you currently do business with.

Reference 1

Company Name

Contact Name

Phone

City / State

Reference 2

Company Name

Contact Name

Phone

City / State

Reference 3

Company Name

Contact Name

Phone

City / State

Authorization & Agreement

I certify that the information provided is true and correct and authorize Center Redi-Mix to obtain credit information from the references provided. I agree that payment terms are Net 30 days from date of invoice unless otherwise agreed in writing.*

Authorized Signer Name*

Title

Date*

Email a copy of this application to me

By submitting this application you agree to Center Redi-Mix payment terms. All accounts are due Net 30 unless otherwise agreed in writing. A 1.5% monthly finance charge will be applied to past-due balances.