Credit Card Intake Form

Sole Proprietor?
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Bonding Agent
Person Responsible for Accounts Payable

Credit References (3 References Minimum)

Credit Reference 1 Name
Credit Reference 2 Name
Credit Reference 3 Name
Credit Reference 4 Name

Banking Information



The Applicant certifies the following: (1) the information I provided is true and correct and has been submitted to obtain commercial credit; (2) I am authorized to execute applications and other documents required to establish commercial credit accounts on behalf of Applicant; (3) Ozark Rebar, LLC is hereby authorized to investigate and verify any information provided and inquire of references or others as to credit worthiness; (4) Ozark Rebar, LLC may answer questions from others about its credit experience with the Applicant; and (5) I have read, understood, and agreed to all of the TERMS AND CONDITIONS and agree to notify Ozark Rebar, LLC, in writing via certified mail, of any material change in name, ownership, location, corporate status, or financial condition within five (5) days. If applicant is a partnership or sole proprietorship, then I authorize Ozark Rebar, LLC to obtain and use consumer reports on the Applicant or its principals for the sole purpose of evaluating current or ongoing credit worthiness.
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