Company/Applicant Information

Please complete this form if you are interested in applying for credit. To complete the application credit, you will need (1) Company Information (2) Owner/Officer Contact Information (3) Trade References (4) Bank and Bonding Company Information (5) Guarantor Information

Company Name(Required)

Fed ID(Required)

Company Address(Required)

City(Required)

State(Required)

Zip(Required)

Phone Number(Required)

Fax Number

Billing Address(Required)

City(Required)

State(Required)

Zip(Required)

Phone Number(Required)

Fax Number

Contact Email(Required)

Company Type(Required)

Year Established(Required)

Business Type(Required)

Website URL

Have you bought from Ernest Maier before?(Required)

Please provide date of purchase & amount

Tax Exempt?

Attach tax exempt form

Max. file size: 100 MB.

Preferred Sales Rep?

Owner/Officer Information

Officer

Officer*(Required)

Role*(Required)

Phone Number*(Required)

Email*(Required)

Payables Contact(Required)

Phone Number(Required)

Email(Required)

Have any of the companies or people listed ever been a debtor in a bankruptcy proceeding?

Yes

No

Are there legal actions or arbitrations pending against any of the companies or people listed?

Yes

No

Trade References

Reference

Reference #

Company*(Required)

Sells*(Required)

City*(Required)

State(Required)

Phone Number*(Required)

Fax Number

Bank & Bonding Company Information

Bank Information (required)

Bank Name(Required)

Account(Required)

Contact(Required)

Phone Number(Required)

Bonding Information (optional)

Bonding Company

Bond#

Contact*

Phone Number

Additional Information

Additional information

Credit Agreement

Requested Credit Line

(This does not limit financial liability on this account).

Requested Credit Line(Required)

Terms and Conditions of Credit Agreement

It is understood that in consideration for extending a credit account the Seller (Ernest Maier, Inc. & dba as Parker Block, Skyline Brick, Bay Ready Mix of Maryland, and Gomoljak Block) and Customer agree upon the following terms and conditions:

Terms

All accounts are due and payable thirty (30) days from the date of the invoice.

Interest

Any account remaining unpaid sixty (60) days from date of invoice will be addressed service charges of 1.5% per month (an effective annual rate of 18%). Interest will accrue from the date of invoice.

Fees

In the event of legal action, Customer shall be responsible for paying reasonable Attorney’s fees incurred by Ernest Maier.

Payments

Customer agrees that Seller has the right to determine how to apply payments and which invoices to pay with all payments received on this account.

Account Status

Seller may stop the sale or supply of any materials when it determines that Customer is in breach of this Agreement or Seller has concerns about Customer’s creditworthiness, until payment is made and any dispute or insecurity has been resolved.

Refunds/Returns/Credits

Customer agrees that refunds/returns/credits not applied six (6) months from invoice date expire. Seller has the right to determine how to apply returns/credits on the account as it sees fit after 90 days.

Releases/Waivers

All waivers executed by Seller shall be effective only to the total dollar amount of payments actually received. Customer agrees that Seller does not release its mechanic’s lien, payment bond or other legal rights for unpaid invoices, regardless of what other documents have been presented to Seller for signature that may imply otherwise.

Delivery

Any deliveries made are to be within the normal weekday and Seller does not guarantee delivery times or rates.

Terms and Conditions

Signature

Should I choose not to sign the above personal guarantee, I understand that the terms of my line of credit may be impacted.

Signer Name(Required)

Signer Title(Required)

Signed Date(Required)

Credit application not accepted without approval from Ernest Maier, Inc.’s Credit Department

Personal Guarantee

In consideration for, and as an inducement to the Seller (Ernest Maier, Inc. & dba as Parker Block, Skyline Brick, Bay Ready Mix of Maryland, and Gomoljak Block) to extend credit to the individual owner/officer named above (hereinafter “Customer”), the undersigned Guarantors hereby personally guarantee to Seller the payment of any obligation of the Customer, and agree to pay Seller on demand any sum which may become due by the Customer whenever the Customer shall fail to pay the same. It is understood that this guarantee shall be a continuing and irrevocable guarantee and indemnity for such indebtedness of the Customer. Written notice of termination of the Personal Guarantee is required by Ernest Maier Inc. Guarantors do hereby waive notice of default, nonpayment and notice hereof and consent to any modification or renewal of the credit agreement. *Guarantor must be listed in the owner/officer contact information*

Guarantor #1 - Signature(Required)

Guarantor #1 Name(Required)

Signed Date(Required)

Guarantor #2 - Signature (optional)

Guarantor #2 Name

Signed Date

Untitled

First Choice

Second Choice

Third Choice

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Credit Application