HOOPA TRIBAL ROADS AGGREGATE AND READYMIX POST OFFICE BOX

HOOPA TRIBAL ROADS AGGREGATE AND READYMIX POST OFFICE BOX




HOOPA TRIBAL ROADS, AGGREGATE, AND READYMIX

HOOPA TRIBAL ROADS, AGGREGATE, AND READYMIX

Post Office Box 789

Hoopa, Ca. 95546

(530) 625-4017 Fax: (530) 625-4021


APPLICATION



Name: Date:


Company name: (if different)

HOOPA TRIBAL ROADS AGGREGATE AND READYMIX POST OFFICE BOX

Address:


Telephone: Social Security/Resale Permit#:


Tax Status: (Attach proof or sales tax will be added to your invoice)


Bank References


Bank: Account number:


Years with banking institution: Checking/Savings (circle)


Credit References

Name Credit Limit:

Address

Telephone May we contact? Yes or No (circle)


Name Credit Limit:

Address

Telephone May we contact? Yes or No (circle)


Name Credit Limit:

Address

Telephone May we contact? Yes or No (circle)


If you are claiming Indian tax exemption, you must obtain an Indian tax exempt letter from the Tribe and provide it to this department or sales tax will be charged. If you are a business and claim tax exemption, you must provide this department with a copy of your resale permit or you will be charged sales tax.

By signature below, you certify that the information above is accurate to the best of your ability and you agree that we are authorized to contact any of the references listed above. Payment for invoices are due within 30 days from the date of service. If this application is for a company, then your signature below means that you are an authorized representative of said company and have the authority to authorize contracts.

If your account is not paid in full within 30 days, you will be charged interest at the rate of 1 ½% per month on all outstanding amounts until paid in full.



Signature: Date:

Job Information (if available):





Tags: tribal, aggregate, office, hoopa, readymix, roads