Go to Top

Credit Application-form

CONFIDENTIAL CREDIT APPLICATION

AMERICAN CONCRETE, PAINT & DRYWALL WASHOUTS – Established in 2004
P.O. BOX 488
FOLSOM, CA 95763
Office (916) 990-0842

Company Name

Billing Address

City, State, Zip Code

Business Address if different than above

Phone

Fax

Accounts Payable Contact

Email Address

Type of Business

Federal Tax ID#

Contractors License#

Exp

Date business established

Years in business

Do you require a Purchase order?
 Yes No

Name(s) of Principles:                                            Enter principles email address
    

    

    

    

Trade References:

Name:

Address

City/State/Zip Code:

Contact Name:

Phone#

Reference #2

Name:

Address

City/State/Zip Code:

Contact Name:

Phone#

E-Signature - Please enter your full name

 Download our Terms and W-9 HERE . Selecting this checkbox states that you are an authorized representative of your company and agree to American Concrete Washout’s terms and understand services will be interrupted if not paid within 30 days of receipt of invoice. An interruption of services may result in SWPPP violations, job shutdowns and other problems with not maintaing your concrete washout. We do not allow our equipment to be moved by anyone besides ACW as damages can occur.