APPLICATION FOR CREDIT
BY:
__________________________________________________________________________________________
NAME OF FIRM OR INDIVIDUAL
_________________________________________________________ YEARS AT THIS ADDRESS _________
ADDRESS
_____________________________________________________________
CITY
STATE
ZIP
_________________________
AREA CODE
PHONE
HEREBY applies for credit in accordance with the terms and conditions of:
TO:
FINLEY BUTTES LANDFILL COMPANY
 WASCO COUNTY LANDFILL
 COLUMBIA RESOURCE COMPANY
OUR NORMAL CREDIT TERMS ARE:
NET 10TH PROX.
P.O. Box 61726
Vancouver, WA 98666
The following information must be provided. It will be held in the strictest confidence.
Corporation
OWNERSHIP:
Check here if incorporated within the past 12 months
Partnership Individual
1. ________________________________________________________________________
NAME(S) OF PRINCIPAL(S)
COMPLETE ADDRESS
ZIP
_________________________
PHONE
2. ________________________________________________________________________
_________________________
Social security # if Partnership or Individual: _________________________________________________________________
FINANCE:
_____________________________________________________________________________________________
BANK
ACCOUNT NUMBER
_____________________________________________________________________________________________
BANK OFFICER OR DEPARTMENT
PHONE
REFERENCES:
1.___________________________________________________________
BUSINESS NAME
COMPLETE ADDRESS
ZIP
__________________
2._________________________________________________________________________
______________________
3._________________________________________________________________________
______________________
4._________________________________________________________________________
______________________
PHONE
Check here if cash sales are okay until credit is approved
Please do not write in the space below
VERIFICATION:
___________________________________________________
REFERENCES CHECKED BY
____________________________________________
CREDIT APPROVED BY
___________________________________________________
REFERENCES RESULTS
____________________________________________
CREDIT REFUSED BY
___________________________________________________
____________________________________________
DATE
___________________________________________________
____________________________________________
SPECIAL WARRANTIES & INFORMATION
1.
To induce the Company to do business with and extend credit to the above applicant: I personally
guarantee performance, payment and collection of all obligations and conditions, whether existing or created in
the future.
2.
I(we) shall not deliver any hazardous waste as defined by: any governmental agency having competent
jurisdiction, nor attempt to hide or conceal any such hazardous waste.
3.
An exemption certificate, from a recognized governmental agency, unless provided with this
application, will result in sales tax being charged for all transactions with you. Once sales tax charges, if any,
are assessed, they must be paid as charged.
4.
The origin of the solid waste we intend to deliver to you is:
_______________________________
MUNICIPALITY
____________________________
COUNTY
___________________
STATE
If applicable, complete the following:
4.1
Our franchise hauler number is: ________________________________________________________
4.2
Our health department number is: ______________________________________________________
4.3
We agree to inform you whenever our permits change.
CREDIT AGREEMENT
The undersigned promise to pay this account in full by the 10th of the month following invoicing. If, however,
this account is not paid as agreed, the undersigned agree to pay in addition to the amount owed, the (interest
charge) stated on the purchase invoice. The customer will reimburse the company for all reasonable collection
cost, and/or reasonable attorney’s fees even if no lawsuit is filed; if a lawsuit is filed, the attorney’s fees shall be
fixed by the court or courts in which the lawsuit, including any appeal, is tried, heard or decided.
For value received, each and every party who signs this agreement or becomes liable either now or hereafter
for the payment of this agreement, severally waives presentment, demand, protest, and notice of non-payment
hereof, binds himself hereon as the principal and not as surety and agrees to remain bound hereon
notwithstanding any extension that may be made to any party liable hereon. At the option of this holder hereof,
the venue of said suit may be laid in the county of the resident of the holder.
THE UNDERSIGNED HEREBY AUTHORIZE AND CONSENT TO ANY CONTACT OR INQUIRY OF ANY
PERSON, CORPORATION OR BUSINESS OF ANY KIND AT THE TIME REGARDING CREDIT STANDING
AND ANY OTHER FINANCIAL INFORMATION. THIS AUTHORIZATION IS IN NO WAY LIMITED TO OR BY
THE TRADE REFERENCE PROVIDED ON THE REVERSE SIDE OF THIS APPLICATION. THE
UNDERSIGNED INDEMNIFY AND HOLD HARMLESS THE COMPANY FROM ANY AND ALL LIABILITY
CONNECTED WITH SUCH CONTACT OR INJURY.
THE UNDERSIGNED HAVE READ AND UNDERSTAND THIS CREDIT APPLICATION AND
ACKNOWLEDGE THAT THE ACCURACY OF THE INFORMATION PROVIDED HEREON IS THE BASIS
FOR THE EXTENSION OF CREDIT.
DATE OF APPLICATION_________________
____________________________
(Signature)
_______________________________
(Signature)