Apply for an Account

Application for Credit Account

COMPANY INFORMATION

Company Name*

Year Company Established*

Physical Address: *

Street AddressCityState / Province / RegionPostal / Zip Code

A/P Contact Name*

A/P Contact Email Address*

Principle's Name/Title*

Website Address:

Billing Address:*

Street AddressCityState / Province / RegionPostal / Zip Code

FEIN*

Description of Business*

TRADE REFERENCES

Trade Reference 1 Name*

Trade Reference 1 Phone *

Trade Reference 1 Email*

Trade Reference 2 Name*

Trade Reference 2 Phone *

Trade Reference 2 Email*

Trade Reference 3 Name*

Trade Reference 3 Phone*

Trade Reference 3 Email *

FINANCIAL INFORMATION

Primary Bank*

Bank Contact Name*

Bank Address*

Bank Phone*

OTHER INFORMATION

ACKNOWLEDGEMENT

We declare that the above information is true, correct and complete and is given to induce Henderson Pit to extend credit. We authorize Henderson Pit to make such credit investigation in accordance with company policies, including contacting the above trade references and banks and obtaining credit reports. We authorize all trade references, banks, and credit reporting agencies to disclose to Henderson Pit any and all information concerning the financial credit history of the company and it’s principles.

A 1 ½ % monthly service charge may be charged on invoices not paid within 30 days of invoice. Credit terms may be revoked and all future orders may be handled on a C.O.D basis. At any time, Henderson Pit has the right to limit the amount of credit extended. If applicant fails to pay Henderson Pit any invoice which becomes past due and Henderson Pit refers such matter to an attorney, applicant agrees to pay, in addition to the amounts owed on invoices, any and all costs and reasonable collection and/or attorney’s fees incurred in collection of the past due invoices. The acceptance of any installment payment by Henderson Pit after an invoice becomes due shall not be a waiver of any rights of Henderson Pit to enforce prompt payment of any further installments or collections. If any action is brought to collect past due invoices, the applicant agrees the venue shall properly lie in Adams County, Colorado.

Acknowledgement: By typing in the Signature Box below, I am acknowledging that I have read the terms and conditions stated and agree to all of those terms and conditions.

Authorized Signature for Credit Application and Terms*

INERT LANDFILL CONDITIONS: Inert material is defined as non-water soluble and non-decomposable material that does not undergo biological, chemical, physical, or radiological transformation. For materials to be considered inert, they cannot contain hazardous wastes or leach hazardous constituents above appropriate surface or groundwater protection levels. By signing below, applicant represents that any material being unloaded in the Henderson Pit by applicant is inert and non-hazardous. Customer is responsible for all clean-up costs associated with depositing any active or hazardous material.

Materials accepted: Clean fill, dirt, earth, rock, clay, soil, sand, gravel, masonry, aggregate, fully cured asphalt, concrete, brick, tile, other inert material.

Materials NOT accepted: Wood, tree trimmings, liquid of any kind, plastics, vegetation, trash, hazardous or contaminated material.

Acknowledgement: By typing in the Signature Box below, I am acknowledging that I have read and understand the definitions and types of inert landfill materials acceptable to Henderson Pit. I understand I am legally and financially liable for the removal of any material unloaded in the Henderson Pit by my company, employees, or agents of my company including clean-up costs, disposal fees, and attorneys fees incurred in the enforcement of any action required.

Authorized Signature for Inert Landfill Terms*