This credit application must be filled in completely. Please print and sign page 2 and send to the address listed on the previous page.

Legal Name of Company: *

Years In Business: *

Address: *

City, State, Zip: *

Billing Address: *

City, State, Zip: *

Phone: *

Fax:

Ownership: *

Type of Business: *

If Other please specify:

Name of Principal 1: *

Title: *

SS#: *

Name of Principal 2:

Title:

SS#:

Authorized Buyers: *

Do You Require A Purchase Order #?: *

  Yes   No

Have You Ever Filed For Bankruptcy?: *

  Yes   No

Sales Tax Information: *

  Exempt   Not Exempt

Tax Exempt #:
Please attach exempt form (required)

Trade References

Business Name 1: *

Address: *

City, State, Zip: *

Phone: *

Fax:

Business Name 2: *

Address: *

City, State, Zip: *

Phone: *

Fax:

The customer agrees to provide a complete address of each job site that material is being purchased for, whether delivered by our company or picked up by the customer. KCG, Inc. DBA Rew Materials reserves the right to notify property ownership of material purchases for the property.

Anticipated Monthly Requirements: *

$

Bank Name: *

Bank Account: *

Bank Address: *

City, State, Zip: *

Contractor License Information

Number: *

Type (Class): *

Address On License: *

Birth Date: *

Credit Agreement: this credit application must be filled in completely. Please print and sign page 2 and send to the address listed on the previous page.

Personal Guarantee: this page is not always necessary. Please print and keep for your records. You will be contacted if Rew needs this documentation from you.

* Indicates a required field.