Credit Application
Tue, 08/04/2009 - 15:23 — mdi

Please provide all the information in this form to apply for a creadit account.

General Information

Billing Address

Physical Address

General Information

If you selected Other from Type of Customer please provide the information here.

Banking Information

$
$

Trade References

Trade Reference 1

Trade Reference 2

Trade Reference 3

If yes, exempt certificate (not a permit) must accompany this application.

The information above is given to obtain an open account with Ridgway's, Ltd. Ridgway's is authorized to make any credit inquiries necessary for approval according to the Federal Fair Credit Reorting Act U.S. Law 91-508(15USC1681). I certify that the above information is correct and that I have the authority to incur liabilities in the name of the company. I understand the credit terms are Net 30 days and the company above agrees to pay Ridgway's, as interest, an amount equal to 1.5% per month, or the maximum provided by law (whichever is less) for the open invoice amounts that are past due.