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Confidential Credit Application(1)

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					                                                    P.O. Box 1290

                                                    Greeley, Colorado
                                                                                                  Confidential
                                                    80632-1290

                                                    Phone. 970-356-9600
                                                                                            Credit Application
                                                    Toll Free. 800-234-0734

                                                    Fax. 970-356-9621

                                                    www.bigrmfg.com




BUSINESS INFORMATION (Including all subsidiaries & affiliates)
Company Name                                                                                         Principal Owner or Officer


Street Address                                                                                       Fed ID #


Billing Address                                                                                      D&B #


City                                        State                         Zip                        Est. Credit Limit


Phone                                               Fax                                              Year Started


A/P Contact Person                                                                                   Email




BUSINESS ENTITY
Corporation                           LLC                                     Partnership                           Sole Proprietorship


What State was the entity formed in?                                          State


Has the customer been involved in any litigation during the past 12 months?                 (Yes)                         (No)




TRADE REFERENCES (Major suppliers)
Name                                                Name                                             Name


City / State                                        City / State                                     City / State


Phone                                               Phone                                            Phone


Fax                                                 Fax                                              Fax




BANK REFERENCE
Bank Name                                                                     Contact Name & Title


City                                                                          Phone


State                                 Zip                                     Fax




Credit Application – Revision 7 (4/1/08)                                                                                                  Page 1 of 4
                                           P.O. Box 1290

                                           Greeley, Colorado
                                                                                Confidential
                                           80632-1290

                                           Phone. 970-356-9600
                                                                          Credit Application
                                           Toll Free. 800-234-0734

                                           Fax. 970-356-9621

                                           www.bigrmfg.com




FINANCIAL STATEMENT (circle one only)                          Attached   To Be Mailed    Will Not Provide


TERMS AND CONDITIONS
By signing below, Customer agrees that all extensions of credit to Customer are subject to the following terms
and conditions:

If Customer fails to make any payment when due, Customer and any guarantor(s) jointly and severally promise
to (1) reimburse Big R Manufacturing, LLC for all reasonable cost of collecting such payments, including
attorney fees and (2) pay interest on such payment at the maximum legal rate. Customer acknowledges that it
has reviewed, and agrees to be bound by, Big R Manufacturing’s standard terms and conditions applicable to
the sale or lease of its products. Extensions of credit by Big R Manufacturing, LLC shall be made on a
transaction-by-transaction basis in the sole discretion of Big R Manufacturing, LLC. Big R Manufacturing, LLC
reserves the right to increase or decrease credit limits as its sole discretion.

Customer warrants that the information provided in or with this application is true and correct. Customer
authorizes Big R Manufacturing, LLC to investigate customer’s credit record and to report customer’s credit
performances to proper persons and/or agencies if/when contacted.



Authorized Signature:

Title:

Print Name:

Date:



  SIGNATURE REQUIRED FOR APPLICATION TO BE CONSIDERED




Credit Application – Revision 7 (4/1/08)                                                                  Page 2 of 4
                                                  P.O. Box 1290

                                                  Greeley, Colorado
                                                                                             Confidential
                                                  80632-1290

                                                  Phone. 970-356-9600
                                                                                       Credit Application
                                                  Toll Free. 800-234-0734

                                                  Fax. 970-356-9621

                                                  www.bigrmfg.com




PROJECT INFORMATION SHEET (Page 1)

A. Amount and Description of Material to be Furnished
Description of Material                            Amount                                            Starting Date



B. Customer Information
Customer’s Full Name                                                        Phone

Street Address

City                                               State                                             Zip



C. Customer Relationship to Project (circle one)                              Owner     General Contractor           Subcontractor   Other
If other, please specify

Is customer installing materials (if applicable)? Indicate YES or NO



D. Project Location
Project Name                                                                Phone

Legal Address

City                                               State                                             Zip



E. Owner / Awarding Authority
Name                                                                        Phone

Street Address

City                                               State                                             Zip



F. Bonding Company or Surety Name
Name                                                                        Contact Person & Phone

Street Address

City                                               State                                             Zip




Credit Application – Revision 7 (4/1/08)                                                                                             Page 3 of 4
                                           P.O. Box 1290

                                           Greeley, Colorado
                                                                                   Confidential
                                           80632-1290

                                           Phone. 970-356-9600
                                                                             Credit Application
                                           Toll Free. 800-234-0734

                                           Fax. 970-356-9621

                                           www.bigrmfg.com




PROJECT INFORMATION SHEET (Page 2)


G. General Contractor
(1) Name                                                             Phone

Street Address

City                                       State                                Zip

(2) Surety Name                                                      Phone

Street Address

City                                       State                                Zip



H. Subcontractor
(1) Name                                                             Phone

Street Address

City                                       State                                Zip

(2) Surety Name                                                      Phone

Street Address

City                                       State                                Zip



I. Architect
Name                                                                 Phone

Street Address

City                                       State                                Zip



To expedite credit procedures, you may email the completed application to theresa@bigrmfg.com. However,
Big R Manufacturing does require having all credit applications signed, so please put a hard copy of the credit
application in the mail.

If there are any questions, please call Theresa Lenhart at 970-347-2211.



Credit Application – Revision 7 (4/1/08)                                                                   Page 4 of 4

				
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