Credit Application

Applicant's Name

DBA (if different from above)

Physical Street Address (no PO Box numbers please)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mailing/Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Billing Contact Name

First NameLast Name

E-mail

Main Phone #

Area CodePhone Number

Fax #

Area CodePhone Number

Cell #

Area CodePhone Number

Federal Tax ID #

Tax Exempt

Yes - please upload completed resale certificateNo

If tax exempt, please upload resale certificate

Upload a File

Principal Officers, Partners or Individual Proprietor

Sole Proprietorship/IndividualPartnershipCorporationOther

Name #1

First NameLast Name

Title

Phone Number

Area CodePhone Number

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name #2

First NameLast Name

Title

Phone Number

Area CodePhone Number

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Bank References

Bank Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Bank Account #

Account Type

Contact

Business References

Account Name #1

Account #

Contact

First NameLast Name

Phone #

Area CodePhone Number

Fax #

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

__________________________________________________________________________________________

Account Name #2

Account #

Contact

First NameLast Name

Phone #

Area CodePhone Number

Fax #

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

I/we certify that the information above is true and correct to the best of my knowledge. I/we authorize Green City Waste & Recycle Solutions Inc. to investigate the references and sources pertaining to the establishment of credit and financial responsibility of the applicant. Any changes to this application must be submitted in writing to the credit office of GCWRS Inc.

Printed Name

First NameLast Name

Title

Date

MonthDayYear

Signature*

Terms

Green City Waste & Recycle Solutions Inc. (GCWRS) terms of payment are as follows: Invoice is due and payable upon receipt. GCWRS may assess a one and a half percent (1.5%) finance charge or the maximum lawful rate, whichever is less, on amounts left unpaid after 30 days of original invoice date. In the event the amount that you owe is required to be collected by an attorney, collection agency or other legal means, in addition to the principal and interest owing, you agree to pay all expenses of collection, including attorney's fees. Applicant's signature attests to the financial responsibility, ability and willingness to pay our invoices in accordance with these terms.

IF APPLICANT IS APPROVED BY GCWRS, APPLICANT AGREES THAT GCWRS'S SERVICES ARE SUBJECT TO, AND APPLICANT AGREES TO BE BOUND BY, THE TERMS AND CONDITIONS PRINTED ON THE SIGNED SERVICE AGREEMENT AND ANY SPECIAL TERMS PERTAINING TO OR SPECIFIC SERVICE SHOWN ON THE INVOICE FOR SUCH SERVICE. APPLICANT REPRESENTS AND WARRANTS THAT HE HAS READ AND UNDERSTANDS THIS AGREEMENT.

Printed Name

First NameLast Name

Title

Date

MonthDayYear

Signature*

Personal Guaranty

All Accounts MUST have a personal guarantor(s)

In consideration of credit to be extended to the Applicant the undersigned does hereby promise and personally unconditionally guarantees to GCWRS or its assigns the payment of such sums of money as is now or may hereafter become due under this agreement to GCWRS or any affiliated or related company for goods and services sold to Applicant. This guarantee shall not be impaired by extension of time or forbearance granted to the Applicant with respect to any credit now outstanding or hereafter extended to Applicant. The indebtedness and/or terms of this agreement may be modified at any time without notice to the undersigned as guarantor notice of demand, presentment, protest, notice of process or payment and/or default under this agreement. The undersigned agrees to pay principal, interest, reasonable attorney's fees and other collection costs allowed by law if it becomes necessary to enforce this guaranty by suit or any other legal means. The undersigned understands the GCWRS need not seek payment from the applicant prior to collecting from the undersigned.

Guarantor #1 Printed Name*

First NameLast Name

Driver's License #*

Social Security #*

Guarantor #1 Signature*

Guarantor #2 Printed Name

First NameLast Name

Driver's License #

Social Security #

Guarantor #2 Signature