CREDIT APPLICATION

Select one of the following companies:(Required)

Gainsborough Waste

Gainsborough Waste Services

Texas Outhouse

Luxury Event Trailers

Company Name(Required)

DBA if applicable

Physical Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Billing Address (if different)

Street Address City State / Province / Region ZIP / Postal Code

Phone Number(Required)

Accounts Payable

Accounts Payable Name(Required)

Email(Required)

Phone Number(Required)

Owners Name(Required)

Phone(Required)

Year Established(Required)

Federal ID Number/Employee Number(Required)

How did you hear about our company?(Required)

List 3 Trade References:

Trade Reference 1

Company Name(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Trade Reference 2

Company Name(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Trade Reference 3

Company Name(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

READ CAREFULLY – This is to certify that our firm is financially able to meet any commitments we have made to pay our invoices according to our terms of net 30 days. All accounts classified as 'past due' will be placed on a C.O.D. basis only until the account is returned to its current status and/or the credit line is re-evaluated. All invoices more than 30 days old may incur an annual interest rate of 18%. There will be a service charge of thirty-five dollars ($35.00) on all returned checks. In the event this account is placed in our Collections Department, applicant agrees to pay all legal and collection costs incurred pursuant to applicable State Laws. Signing this form is an agreement for my Personal Guaranty of Payment. There is a minimum requirement of one (1) haul per container per calendar month. If no service is performed, you will be required to pay applicable rental rates/inactivity fees.

Driveways and Parking Areas - Customer warrants that any right of way provided by Customer for Contractor's equipment location to the most convenient public way is suﬃcient to bear the weight of all Contractor's equipment and vehicles reasonably required to perform the service herein contracted. Contractor shall not be responsible for damages to any private pavement or accompanying sub-surface of any route reasonably necessary to perform the services herein Contracted and Customer assumes all liability for damage to pavement or road service.

Accept Electronic Signature(Required)

I Accept

By checking the "I Accept" checkbox and drawing your signature in the signature box, you are signing this credit application electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Agreement. By checking "I Accept" using any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature.

Signature(Required)

Title

Print Name(Required)

Date(Required)