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04-May-2010
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Beyer's Lumber and Hardware - Established 1946

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BEYERS LUMBER CO. 8684 Olive Blvd. St. Louis, Mo 63132 Phone: 314-993-2445 Fax: 314-993-3572

PART 1 BUSINESS INFORMATION

Company Name

Tax I.D. #

Year Established

Current Business Address

City

State

Zip

Phone

Fax

Email

Years at Current Location

Type of Business

Are you tax exempt? If so, please forward a copy of your Sales Tax Exemption form.
Yes No
# of Employees

President's Full Name

Home Address

City

State

Zip

Home Phone

Bank Reference

Bank Contact

Bank Phone

Do you require job names?
Yes No
Purchase orders?
Yes No
Do you want dray tickets priced?
Yes No

If you want restrictions on who can charge, please list names:

Name: Name: Name:

Name: Name: Name:

Name: Name: Name:

Any other requirements, which you need on your account?

PART 2 INDIVIDUAL or "PRINCIPAL’S" PERSONAL GUARANTEE

Please complete this personal guarantee for all individual credit applications. In the event the company or corporation has minimal business credit data available, it may be necessary to rely on the principal executive’s personal guarantee and credit report to secure your open credit line with Beyers Lumber Co. Please complete all the following information:

Last Name

First Name

Middle Initial

Date of Birth

Current Address

City

State

Zip

Phone

SSN

Drivers License #

PART 3 CREDIT INFORMATION

Please list four business references with whom you have open credit account status:

Name of Company

Phone

Fax

Account #

Name of Company

Phone

Fax

Account #

Name of Company

Phone

Fax

Account #

Name of Company

Phone

Fax

Account #

IN COMPLIANCE WITH THE FAIR CREDIT REPORTING ACT, THIS IS TO INFORM YOU THAT YOU ARE AUTHORIZING THIS ORGANIZATION AND/OR ITS SUPPLIERS TO OBTAIN A CONSUMER AND/OR BUSINESS PROFILE CREDIT REPORT. YOU HAVE THE RIGHT TO DISPUTE THE INFORMATION ON THIS REPORT AND REQUEST ADDITIONAL DISCLOSURES PROVIDED UNDER SECTION 606§1681d(b) OF THE FAIR CREDIT REPORTING ACT, AND A WRITTEN SUMMARY OF YOUR RIGHTS PURSUANT TO SECTION 609(c). YOU MAY DO THIS BY CONTACTING THE PROVIDER OF THE INFORMATION. PLEASE CALL BACKGROUND INVESTIGATIONS, INC. PHONE 1 800 955-1356 AND YOU WILL BE DIRECTED TO THE PROPER CREDIT REPORTING AGENCY OR ASSISTED IN YOUR INQUIRY. THIS ORGANIZATION IS NOT ALLOWED TO GIVE YOU A COPY OF YOUR CREDIT REPORT. YOU ALSO RELEASE FROM LIABILITY ANY PERSONS INVOLVED IN THE CREDIT INVESTIGATION.

I/We certify, to the best of my/our knowledge, that all statements above are true and complete. I/We further authorize Beyers Lumber and its suppliers to obtain any and all information related to credit information and credit worthiness related to obtaining credit from Beyers Lumber. If this account requires submission to an attorney for collection, customer agrees to pay reasonable attorney fees. Terms: Balance is due on the tenth day of the month following the statement date. Accounts not paid by the last day of the month in which due are assessed a finance charge of 1-1/2 % per month (18% A.P.R.).

Company Name	Tax I.D. #		Year Established
Current Business Address	City		State	Zip
Phone	Fax		Email
Years at Current Location	Type of Business
Are you tax exempt? If so, please forward a copy of your Sales Tax Exemption form. Yes No	# of Employees
President's Full Name	Home Address
City	State	Zip	Home Phone
Bank Reference	Bank Contact		Bank Phone
Do you require job names? Yes No	Purchase orders? Yes No		Do you want dray tickets priced? Yes No
If you want restrictions on who can charge, please list names:
Name:	Name:		Name:
Name:	Name:		Name:
Name:	Name:		Name:
Any other requirements, which you need on your account?

Last Name	First Name		Middle Initial	Date of Birth
Current Address	City	State	Zip	Phone
SSN	Drivers License #

Name of Company	Phone	Fax	Account #
Name of Company	Phone	Fax	Account #
Name of Company	Phone	Fax	Account #
Name of Company	Phone	Fax	Account #
IN COMPLIANCE WITH THE FAIR CREDIT REPORTING ACT, THIS IS TO INFORM YOU THAT YOU ARE AUTHORIZING THIS ORGANIZATION AND/OR ITS SUPPLIERS TO OBTAIN A CONSUMER AND/OR BUSINESS PROFILE CREDIT REPORT. YOU HAVE THE RIGHT TO DISPUTE THE INFORMATION ON THIS REPORT AND REQUEST ADDITIONAL DISCLOSURES PROVIDED UNDER SECTION 606§1681d(b) OF THE FAIR CREDIT REPORTING ACT, AND A WRITTEN SUMMARY OF YOUR RIGHTS PURSUANT TO SECTION 609(c). YOU MAY DO THIS BY CONTACTING THE PROVIDER OF THE INFORMATION. PLEASE CALL BACKGROUND INVESTIGATIONS, INC. PHONE 1 800 955-1356 AND YOU WILL BE DIRECTED TO THE PROPER CREDIT REPORTING AGENCY OR ASSISTED IN YOUR INQUIRY. THIS ORGANIZATION IS NOT ALLOWED TO GIVE YOU A COPY OF YOUR CREDIT REPORT. YOU ALSO RELEASE FROM LIABILITY ANY PERSONS INVOLVED IN THE CREDIT INVESTIGATION. I/We certify, to the best of my/our knowledge, that all statements above are true and complete. I/We further authorize Beyers Lumber and its suppliers to obtain any and all information related to credit information and credit worthiness related to obtaining credit from Beyers Lumber. If this account requires submission to an attorney for collection, customer agrees to pay reasonable attorney fees. Terms: Balance is due on the tenth day of the month following the statement date. Accounts not paid by the last day of the month in which due are assessed a finance charge of 1-1/2 % per month (18% A.P.R.).

Name:

Email: