Fill Our Our Credit Application

Customer’s Legal Name:*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Preferred Verification:*

Bus. Fed. Tax I.D. #*

Owner Soc. Sec. #*

Type of Business:*

Website*

Principal Business Activity:*

Date Started:*

MM

DD

YYYY

Date Incorporated:

MM

DD

YYYY

Have you ever operated under any other name? If so, what name?*

Names, Addresses, Social Security Numbers and Titles of Owners, Partners, or Officers:

Name	SSN	Title

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Has the Customer or any of its officers, principals, or partners ever declared bankruptcy? If so, who and when?*

Credit References

Credit References*

Name	Address	Telephone Number

Please enter 3 - use the + button to create more rows.

Bank References

Bank references*

Bank Name	Account Nos	Street Address:	City:	Telephone No.:

You may enter up to 2 - use the + button to create more rows.

HARDING MATERIALS, LLC DISCLAIMS ANY AND ALL WARRANTIES, WHETHER EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICUALR PURPOSE. IF THE GOODS SOLD PURSUANT TO THIS CREDIT APPLICATION ARE DEFECTIVE, CUSTOMER’S SOLE REMEDY SHALL BE THE REPLACEMENT OR REPAIR, AT THE OPTION OF HARDING MATERIALS, LLC OF THE DEFECTIVE ITEM.

Terms and Conditions

Payment is due within fifteen (15) days from date of invoice. Accounts are delinquent if not paid in full by the 30th day after the date of invoice. Credit privileges may be unilaterally terminated by Harding Materials, LLC on delinquent accounts. This credit application and any contemporaneous or subsequent agreements between the parties shall be governed as to validity, interpretation, construction, effect, and in all other respects by the laws of the State of Indiana. The parties further agree that any suit brought by either party arising out of or relating to this agreement shall only be brought in court located in Marion County, Indiana.
Notwithstanding the above and regardless of the circumstances, Harding Materials, LLC’s total liability to the Customer for any and all claims, losses, or damages arising out of any cause whatsoever, whether based in contract, negligence or other tort, strict liability, breach of warranty or otherwise, shall in no event exceed the purchase price of the goods from which such cause arose. In no event shall Harding Materials, LLC be liable for special, incidental, punitive, consequential, or exemplary damages. Harding Materials, LLC shall neither be held responsible nor be liable for any delays in providing the asphalt materials. Title to goods and risk of loss shall pass to the Customer upon the loading of the asphalt materials into the Customer’s transport.
The Customer shall defend and indemnify Harding Materials, LLC, and its agents and employees, against, and compensate it for, all claims, damages, and expenses, including attorney’s fees, arising out of or resulting from the performance of the Customer’s services or work, but only to the extent caused by the failure to abide by this Agreement or by the negligent acts or omissions of the Customer, its laborers, employees, subcontractors, suppliers and anyone for whose acts they may be liable, regardless of whether or not such claim, damage, loss or expense is caused in part by a party indemnified hereunder.
The Customer hereby represents that it is, and will continue to be, financially able to meet any commitments it has made or may make. The Customer agrees to pay all invoices in a timely fashion and in accordance with the terms and conditions stated thereon and herein. In the event the Customer fails to pay any amount when due and if this account is placed in the hands of a collection agency or attorney for collection, or legal action, Customer agrees to pay an additional charge equal to the cost of collection including agency or attorneys' fees and expenses and court costs incurred by Harding Materials, LLC in exercising its rights hereunder. In addition, all accounts shall accrue interest at 1.5% per month, equal to 18% annually, from the due date of the invoice until paid.

Please Confirm*

I agree to the above Terms and Conditions

Digital Signature*

By using your legal name, you are agreeing with the above Terms and Conditions.

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Contact Details - Principals*

Legal Name	Address	City, State, Zip	SSN

Please include the following information for all Principals.

Harding Materials, LLC Credit Application

Credit References

Bank References

Terms and Conditions

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