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Billing Purpose Only

Account #
Contract #
Approval Signature #

Type Of Business
CorporationIndividualPartnershipLimited Partnership

Full Legal Name

Doing Business As

Tax ID #

Social Security #

How Long In Business?

Location Address

Billing Address

Billing Phone #

Officers

Name

Title

Phone #

Name

Title

Phone #

Name

Title

Phone #

Credit References

Vendor Name

Address, City and State

Acct #

Phone #

Vendor Name

Address, City and State

Acct #

Phone #

Vendor Name

Address, City and State

Acct #

Phone #

Bank Information

Name

Acct #

AUTHORIZATION/TERMS AND CONDITIONS

The undersigned certifies this application is for credit and authorizes Bay Disposal or its assignee to investigate all information contained herein. The undersigned authorizes and requests all parties to release any information requested concerning personal or business credit standing.

Applicant
Print Name & Title
Date

Personal Guaranty

In order to induce Bay Disposal to extend credit to Applicant, the undersigned does hereby absolutely, unconditionally and personally guarantee to Bay Disposal the payment of all indebtedness and performance of all obligations of whatever nature of the above Applicant to Bay Disposal as they come to be due or accelerated whether such indebtedness and obligations exist on the date of this instrument or are incurred after such date.

Applicant
Print Name & Title
Date