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

Date of Birth(Required)

Social Security Number(Required)

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 attorney's fees equal to thirty-three percent (33%) of the outstanding balance, together with all court costs, collection costs, expenses, and any additional attorney's fees incurred by Seller in collecting the indebtedness, to the extent permitted by applicable law.

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 suspend or discontinue the sale or supply of materials, revoke or modify credit terms, require payment in advance or additional security, or otherwise limit the extension of credit whenever Seller determines, in its sole discretion, that Customer is in breach of this Agreement, Customer's creditworthiness has materially changed, Customer has failed to timely pay amounts due, or Seller believes its lien, bond, or other legal rights may be impaired.

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.

Governing Law; Venue Jurisdiction

This Credit Application, and the rights and remedies arising hereunder, shall be interpreted, governed, construed and enforced under the laws of the State of Maryland, without regard to conflict of law principles. Customer consents to and agrees that any legal action or proceeding arising out of or relating to this Credit Application or the extension of credit shall be brought exclusively in the Circuit Court for Montgomery County, Maryland, in any other court of the State of Maryland having jurisdiction, or in the United States District Court for the District of Maryland. Customer knowingly and voluntarily submits to the jurisdiction of such courts and waives any objection based upon venue or forum non conveniens.

Terms and Conditions

Consent(Required)

By checking this box, I agree to the listed terms and conditions.(Required)

It is understood that in consideration for extending a credit account the Seller (Ernest Maier, Inc. d/b/a 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 the date of invoice will be assessed 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 attorney's fees equal to thirty-three percent (33%) of the outstanding balance, together with all court costs, collection costs, expenses, and any additional attorney's fees incurred by Seller in collecting the indebtedness, to the extent permitted by applicable law.

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 suspend or discontinue the sale or supply of materials, revoke or modify credit terms, require payment in advance or additional security, or otherwise limit the extension of credit whenever Seller determines, in its sole discretion, that Customer is in breach of this Agreement, Customer's creditworthiness has materially changed, Customer has failed to timely pay amounts due, or Seller believes its lien, bond, or other legal rights may be impaired.

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 ninety (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.

GOVERNING LAW; VENUE; JURISDICTION: This Credit Application, and the rights and remedies arising hereunder, shall be interpreted, governed, construed and enforced under the laws of the State of Maryland, without regard to conflict of law principles. Customer consents to and agrees that any legal action or proceeding arising out of or relating to this Credit Application or the extension of credit shall be brought exclusively in the Circuit Court for Montgomery County, Maryland, in any other court of the State of Maryland having jurisdiction, or in the United States District Court for the District of Maryland. Customer knowingly and voluntarily submits to the jurisdiction of such courts and waives any objection based upon venue or forum non conveniens.

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. d/b/a 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 Guarantor hereby personally guarantees to Seller the payment of any obligation of the Customer, and agrees 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. Guarantor does hereby waive notice of default, nonpayment and notice hereof and consent to any modification or renewal of the credit agreement. The undersigned Guarantor further agrees that this Guaranty is absolute and unconditional and shall remain in full force and effect until Seller receives written notice of termination from the Guarantor; provided, however, that such termination shall not affect any obligations incurred prior to Seller's actual receipt and acknowledgment of such notice. The undersigned Guarantor represents that the information provided below is true and correct and agrees to promptly notify Seller in writing of any change in residence address. The Guarantor acknowledges that Seller is entitled to rely upon the information provided herein for purposes of extending credit, collecting any indebtedness, and enforcing this Guaranty. *Guarantor must be listed in the owner/officer contact information*

Guarantor #1 - Signature(Required)

Guarantor #1 Name(Required)

Signed Date(Required)

Social Security Number(Required)

Date of Birth(Required)

Guarantor #1 Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Guarantor #2 - Signature (optional)

Guarantor #2 Name

Signed Date

Social Security Number

Date of Birth

Guarantor #2 Home Address

Street Address Address Line 2 City State ZIP Code

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Credit Application