Credit Application – Streamlined Billing in 4 States

Simon Credit Application

Recitals: This Credit Application/Agreement (herein referred to as “Agreement”), made by the undersigned applicant (herein referred to as “Applicant”) and one or more of the following legal entities; Simon Contractors (parent), Simon Contractors of South Dakota Inc., McAtee Construction Company, or any of their d/b/a/’s; Simon, Simon Materials, Simon Construction (herein collectively and individually referred to as “Company”) shall be as follows: This Agreement modifies, supersedes, and replaces in its entirety any previous agreements by and between the parties hereto with regard to the subject matter of this Agreement. The parties are fully competent to transact business and request to enter into an Agreement to have the Company extend credit to the Applicant. Each of the parties hereto is properly authorized by action of their respective governing boards, if any, to enter into this Agreement. Now, therefore, in consideration of the mutual covenants contained herein, and each of the parties intending to be legally bound hereby, it is mutually agreed as follows.

Ratification: The parties hereto acknowledge that the foregoing recitals are true and correct and adopt the same as a material part of this agreement.

Credit Limit Requested: $(Required)

(Note: Requested credit limit should be supported by credit references.)

Applicant/Entity Legal Name:(Required)

Physical Address(Required)

Street Address Address Line 2 City State ZIP Code

Mailing Address(Required)

Same as Physical Address

Street Address Address Line 2 City State ZIP Code

Phone Number(Required)

Fax Number

Billing Information

Billing Contact(Required)

First Last

Billing Email(Required)

Indicate your preferred method of receiving Daily Invoices and Monthly Statements:(Required)

Mail

If EMAIL, please provide preferred email if different from above:

Purchase Type(Required)

Select all that apply.

Primary Purchase Location(s):(Required)

Bank Reference (Primary Bank)

Bank Name:(Required)

Bank Address:(Required)

Street Address Address Line 2 City State ZIP Code

Account Number:(Required)

Name of Bank Contact:(Required)

Phone:(Required)

Fax Number:

Email:(Required)

Trade Reference #1

Name(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Fax

Email(Required)

Trade Reference #2

Name(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Fax

Email(Required)

Trade Reference #3

Name(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Fax

Email(Required)

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Internal use only:

MFG

CON

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Generated By:

Authorization to Release Information

Credit Release Date:(Required)

The undersigned hereby authorizes the Credit Department of Simon Contractors (parent) and Simon Contractors of South Dakota Inc. to obtain information to accounts of deposit, credit obligations and all other matters which they may require in connection with my (our) request for establishing a credit limit.

This form MAY BE REPRODUCED AND THAT COPY SHALL BE AS EFFECTIVE AS THE ORIGINAL AUTHORIZATION which I (we) have signed.

All information obtained will be held in strict confidence.

Company/Sole Proprietor Name:(Required)

Company Representative Name:(Required)

Company Representative Title:(Required)

Company Address:(Required)

Same as Physical Address

Phone(Required)

Fax Number

Signature

Agreement to Terms

The Applicant, by and through agent (Principal or Corporate Officer) verifies and agrees as follows:

All information given in this Agreement is true and correct as of the date hereof and is freely offered for the sole purpose of obtaining credit from Company. Full permission is given to investigate the validity of the information from any source deemed appropriate.

Payment for items purchased is due in full 30 days from the date of invoice, i.e., “net 30 days from the date of invoice.”

A service charge of 1½% per month will be charged on all account balances outstanding thirty (30) days or more. Applicant shall pay all collection costs, including attorney’s fees as allowed by law if the same is placed in the hands of an attorney for collection or suit by Company. Any disputes as to the quality of the goods/materials purchased must be made within 10 days from receipt of the goods/materials in writing.

Applicant agrees to provide Company a copy of the following documents/information prior to Applicant’s receipt of any materials: (1) a copy of the Notice of Commencement filed for the project by the general contractor or owner, and if such notice has not been filed, then Applicant must provide (2) the name and address of the project, owner, and location of the property on which the materials purchased are being installed; and (3) a copy of any and all payment bonds, performance bonds, or any other bonds associated with the project. Company reserves all lien rights under the law, including the right to file a notice to contractor, claim of lien, claim on bond, foreclosure action, etc. related to the project.

The Applicant must provide physical addresses of where products are being shipped prior to loading at any of Company’s facilities. Applicant may provide Company a list of current jobs, addresses, and owners to alleviate having to provide the information daily; however, it will be the Applicant’s responsibility to provide the job number prior to loading and ensure that the ticket reflects the correct job and physical address.

Any person signing on behalf of the Applicant attests that the Applicant is a valid business entity, that if applicable, the execution of this application has been duly authorized by all necessary action(s) of the Applicant’s governing body, and that the undersigned is authorized to make this application on Applicant’s behalf.

Miscellaneous:

In entering into this Agreement, neither party has relied upon any statement, representation, warranty, nor agreement of the other party except for those expressly contained in this Agreement.

This Agreement shall in all respects be interpreted, enforced, and governed under the laws of the State of Wyoming with venue in Cheyenne, Wyoming, without regard to Wyoming’s choice of law provisions. Applicant hereby irrevocably submits and agrees to the personal jurisdiction and venue of the Federal and/or State Courts located in, or having jurisdiction over, Laramie County of Wyoming, City of Cheyenne, in any action or proceeding arising out of or relating to, this Agreement, and its enforcement, and agrees that all claims in respect of any such action or proceeding may be heard and determined in either such court; and each party waives the right to change of venue and the right to a jury trial.

Applicant hereby irrevocably consents to the service of any summons or complaint, and any other process that may be served in relation to this Agreement by any of the following methods: (1) mailing copies of such process via certified or registered mail at the Applicant’s address(es) as set forth herein; (2) by personal service; or (3) any other method allowed by law or as may be directed by the Court in which such proceedings are filed.

This Agreement constitutes the final agreement between the parties. It is the complete and exclusive expression of the parties’ agreement on the matters contained herein. All prior and contemporaneous negotiations and agreements between the parties on the matters contained in this Agreement are expressly merged into and superseded by this Agreement.

This Agreement shall not be modified, amended, altered or changed except by written document agreed and signed by the parties. Whenever the Agreement so requires, singular words shall be construed in the plural and vice versa, and the masculine gender shall be construed to include the feminine and vice versa.

The provisions of this Agreement are severable; if any provision of this Agreement is determined by a court of competent jurisdiction to be invalid, illegal, or unenforceable, the remaining provisions of this Agreement remain in full force, as long as the essential terms and conditions of this Agreement for each party remain valid, binding, and enforceable.

This Agreement shall be binding upon and take inure to the benefit of the parties and their respective heirs, personal representatives, successors in interest and assigns.

The rule of contract construction that ambiguities in a document will be construed against the party who drafted it will not be applied in interpreting this Agreement. Any uncertainty or ambiguity existing herein shall not be interpreted against either party because such party prepared any portion of this Agreement, but shall be interpreted according to the application of rules of interpretation of contracts generally.

This Agreement does not and is not intended to confer any rights or remedies upon any third party.

No agency, partnership, joint venture or any other special relationship between the parties is created by this Agreement.

The parties specifically agree to execute all necessary documents to carry out the terms, purposes, and intent of this Agreement.

Click submit below to complete the data entry portion of the Simon Contractors Credit Application.

After submitting, you will be taken to a page to electronically sign the application. You must electronically sign the application in order for us to begin processing it.

Signature

Simon Credit Application

Simon Credit Application

Billing Information

Company Information

Bank Reference (Primary Bank)

Trade Reference #1

Trade Reference #2

Trade Reference #3

Authorization to Release Information

Agreement to Terms