Credit Application CREDIT APPLICATION FORM Please fill out all fields. An incomplete Credit Application may delay the final credit decision. Note: For your security, our website includes SSL, security and encryption for the safety of your information. Step 1 of 7 14% Legal Name (First/Last)* Trade Name* Phone Number*Fax NumberCheck One* LLC Gen. Partnership Ltd. Partership Sole Proprietor Government Physical Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Mailing Address (if different from Physical Address) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Year Started* Approximate Annual Sales* Credit Line Requested*A/M Code* Name of Accounts Payable Contact (First/Last)* Title* Resale Number* Phone (if different from above)Email* Customer Trade ReferencesPlease provide three references:Reference Name (First/Last)* Phone*Reference Name (First/Last)* Phone*Reference Name (First/Last)* Phone* Bank ReferencePlease provide a bank reference:Account Number(s)* Bank Name* Branch Bank Officer (First/Last)* Bank Officer's Title* Phone*Phone Extenstion # Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Payment History* AcknowledgementIt is understood and agreed that the undersigned specifically consents to the investigation of the applicant’s credit history for the purpose of establishing credit. The undersigned authorizes their bank and trade references to release the information requested for the processing of this credit application. Upon request, the undersigned agrees to sign a joint check authorization with any or all of the aforementioned operation subsidiaries of Robar Enterprises, Inc., AgCon, Inc. or Daily Transit Mix, LLC. Applicant agrees to Purchase Agreement & Terms.Date* MM slash DD slash YYYY Signature (Owner or Corporate Officer)*Name (First/Last) of Above Signatory* Contractors License Number* State(s)* Classification* List Job(s) in Progress or Pending*Bonding Company* Bonding Number* Capacity* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone* General Information for Corporate Officers, Partners, or Sole ProprietorsLegal Name (First/Last)* Title* Home Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code % Ownership* Please tell us the % (percent) of ownership.Home Phone*Mobile Phone*Social Security Number* ###-##-####Driver's License Number | State of Issue* Please provide driver's license number and state Legal Name (First/Last)* Title* Home Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code % Ownership* Please tell us the % (percent) of ownership.Home Phone*Mobile Phone*Social Security Number* ###-##-####Driver's License Number | State of Issue* Please provide driver's license number and state Legal Name (First/Last)* Title* Home Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code % Ownership* Please tell us the % (percent) of ownership.Home Phone*Mobile Phone*Social Security Number* ###-##-####Driver's License Number | State of Issue* Please provide driver's license number and state Purchase Agreement & Terms Payment is due for materials, products, and/or services purchased when such materials, products, and/or services are picked up or delivered to an agreed location. Payment shall be received in our office no later than thirty (30) days from the date of invoice for such materials, products and/or service. The account will be considered past due if Payment for an invoice is not received within thirty (30) days of the invoice date. If payment is not received within forty-five (45) days, a service charge on the unpaid balance shall accrue at the rate of 2% per month. Nonpayment of the amount invoiced beyond forty-five (45) days will result in damages and expenses for billing, clerical, accounting, postage, and administrative costs, which are not capable of precise calculation. Thus, a service charge of 2% per month will be added to the account as liquidated damages, which the applicant expressly agrees to pay. Upon approval, credit is being granted by the principal offices of Robar Enterprises, Inc., HiGrade Materials Co., Endura Steel, Inc, Smith Ironworks, AgCon, Inc. & Daily Transit Mix, LLC in Hesperia, California. Should it be necessary for Robar Enterprises, Inc., HiGrade Materials Co., Endura Steel, Inc, Smith Ironworks, AgCon, Inc. & Daily Transit Mix, LLC to initiate legal proceedings in the collection of any balance due on this account, such action shall be brought and tried in the San Bernardino County Trial Court – Desert District, Victorville, California. Applicant agrees to pay collection costs, and reasonable attorney fees, if legal action is instituted to enforce the terms of this Agreement. Credit Cards may be charged a 3% surcharge. Delivery Conditions: Seller shall deliver Materials to the curb line only, unless Buyer otherwise instructs, in which case, Buyer shall assume all liability for, and defend and indemnify Seller from and against, any damage to sidewalks, driveways, curbs, or other property on or about the job site caused by the weight of the load, or the presence of the Seller’s trucks. Buyer acknowledges that it shall be solely responsible for the location of delivery, method of unloading, and placement of Materials on the job site, including traffic control and the on-site direction of Seller’s vehicles to, at, and from the designated location. Buyer shall ensure, and assume full responsibility for providing, suitable access, roadways and approaches to/from points of delivery, and shall be responsible for all damage, loss, injury or expenses, including, without limitations, the removal of mud from truck wheels or tires, spillage of, or damage to the Materials, and towing fees, sustained by Seller as a result of unsuitable or special job site conditions. Seller’s drivers shall have the right to either refuse or delay delivery or placement of Materials at a job site where Seller’s drivers, in their sole discretion, deem the job site, or any portion thereof, to be unsafe or unsuitable for purposes of delivering or placing Materials. Assumption of liability/ Indemnification: In consideration of Seller’s manufacture and delivery of materials pursuant to Buyer’s order(s), Buyer accepts sole responsibility for, and shall release, defend (with counsel satisfactory to Seller), indemnify and hold Seller ad its employees, affiliates and agents harmless from and against any and all losses, damages, liabilities, expenses, costs and claims, arising from (i) the movement of Seller’s vehicles on or about the delivery location, (ii) the addition of water, color additives, water reducing and/or retarding admixtures, super-plasticizers, or any other materials, additives r agents which are added by, on behalf of, or at the direction of the Buyer, the owner of the job site property, their respective representatives or agents, and any other third party on behalf of the Buyer or owner, (iii) variations in color, surface discoloration, blisters, spalls, shrinkage or subgrade settlement cracks, crazing, curling, delamination, dusting, pop-outs, or variations in the finished product caused by finishing techniques, reactive agents, lack of sufficient compaction, or job site conditions (including alkali silica reactivity), (iv) the pumpability of any Materials, (v) Buyer’s failure to account for the effect of ambient temperatures on the Materials, including, without limitation, Buyer’s failure to make arrangements with the Seller (at Buyer’s sole expense) to implement adequate temperature controls to mitigate the effects ambient temperatures may have on the slump, placement and/or set time of Materials, (vi) Buyer’s failure to provide for a suitable concrete wash-out area that is in compliance with applicable law, (vii) compressive strength that exceeds mix design specifications, (viii) Materials being different, inappropriate, incompatible, improper or inconsistent with (A) plans and specifications which were not provided to, and accepted in writing by Seller, prior to Buyer’s ordered for such Materials, or (B) with the ground soils or conditions on the land where the Materials are utilized. Prevailing wage requirements: Buyer expressly agrees to give written notice to Seller in the event any orders placed by Buyer are for the purpose of carrying out a public works contract that is subject to prevailing wage requirements. Such written notice shall include the identity and contact information of the general contractor and public entity. Seller confirms, and Byer agrees, that such orders require compliance with the requirements of the Public Works Chapter of the Labor Code. Buyer shall defend and indemnify Seller for any losses, fees fines, penalties, damages, claims and expenses (including attorney’s fees) arising from Buyer’s failure to comply with the terms hereof. Proposition 65 Notice (California Only): Warning: This product contains chemicals known to the State of California to cause cancer, birth defects, or other reproductive harm. Date* MM slash DD slash YYYY Name (First/Last) Signature*Owner or Corporate Officer Signature Personal GuaranteeIn consideration of credit granted, the undersigned personally guarantees any and all charges and or monies due: this sum to include any and all attorney’s fees and collection costs. In the event that the past due payment is demanded, the undersigned agrees to personally make such payment with ten (10) days of written request. Neither Robar Enterprises, Inc., AgCon, Inc. Daily Transit Mix, LLC nor any of its subsidiaries, shall be required to pursue recovery from the principal debtor as a condition of pursuing recovery from the Guarantor. Additionally, guarantor shall waive any and all statutes of limitation periods, which may be applicable to the collection of the obligations owing hereunder.Date* MM slash DD slash YYYY Signature (Owner or Corporate Officer)*Name (First/Last) Δ