GET A QUOTE

Credit Application

Legal Business Name *
DBA
Federal Tax ID (EIN) *
State of Incorporation
Year Established
Business Type
Primary Business
Physical Address *
Billing Address
Accounts Payable Address (if different)

Primary Contact

Name
Title
Phone
Email *

Accounts Payable Contact

Name
Phone
Email

Purhcasing Contact

Name
Phone
Email

Project Manager

Name
Phone
Email

Authorized Purchaser #1

Name
Title
Phone

Authorized Purchaser #2

Name
Title
Phone

Authorized Purchaser #3

Name
Title
Phone

Credit Information

Requested Credit Limit
Other - Requested Credit Limit
Estimated Monthly Purchases
Largest Anticipated Single Project
Average Number of Ready-Mix Orders Per Month
Current Annual Revenue
Number of Employees

Company History & Credit Issues

Have you ever filed bankruptcy?
If yes, please explain:
Have you had any judgments, liens, or collection actions within the last five years?
If yes, please explain:

Bank Reference

Bank Name
Branch
Account Officer
Phone
Email

Trade Reference #1

Company
Contact
Phone
Email

Trade Reference #2

Company
Contact
Phone
Email

Trade Reference #3

Company
Contact
Phone
Email

Bonding Information (If Applicable)

Bonding Company
Bond Agent
Phone
Aggregate Bonding Capacity
Single Project Limit

Insurance Information

Insurance Carrier
Agent
Phone
Policy Expiration

Sales Tax

Is your company tax exempt?
Sales Tax Exemption Certificate
Maximum file size: 20 MB

Required Documents

Please provide the following documents:

• W-9
• Certificate of Insurance
• Driver’s License

Financial Statements
May be requested as part of the credit review process.

Supporting Documents
Maximum file size: 50 MB
Upload all applicable supporting documents here. Multiple files may be uploaded.

Terms of Billing, Collection & Credit Agreement

  1. Silverback Concrete invoices customers daily for ready-mix concrete, pumping, materials, and related services.
  2. Payment is due seven (7) calendar days from the invoice date unless otherwise agreed to in writing.
  3. Any invoice not paid within ten (10) calendar days after its due date shall be considered delinquent.
  4. Delinquent balances shall accrue interest at the maximum rate permitted by applicable law:

• Florida – 18% annually (1.5% per month)

• Virginia – 10% annually (0.833% per month)

  1. Customer statements will be issued monthly listing all unpaid invoices.
  2. Silverback Concrete reserves the right to suspend deliveries, orders, pumping services, credit privileges, or future work whenever an account becomes delinquent or exceeds its approved credit limit.
  3. Silverback Concrete reserves all rights available under applicable lien laws, including but not limited to Chapter 713, Florida Statutes, and may file construction liens, bond claims, or pursue any other legal remedies available to recover unpaid balances.
  4. A $50.00 fee will be charged for all returned checks.
  5. Customer agrees to pay all costs associated with collection of delinquent accounts, including reasonable attorney's fees, court costs, collection agency fees, interest, and all other collection expenses permitted by law.
  6. Venue for any legal action arising under this Agreement shall be in Alachua County, Florida, unless otherwise required by applicable law.
  7. Silverback Concrete reserves the right to modify, reduce, suspend, or revoke any credit limit at any time.
  8. Customer agrees to notify Silverback Concrete immediately of any change in ownership, legal structure, mailing address, financial condition, or management.
  9. Applicant authorizes Silverback Concrete to obtain commercial credit reports, trade references, banking references, and any other information reasonably necessary to evaluate this application.
  10. Submission of this application does not guarantee approval of credit.
  11. Credit limits and payment terms are granted solely at the discretion of Silverback Concrete.

New Customer Payment Policy

Silverback Concrete does not extend open lines of credit to first-time customers.

Unless otherwise approved in writing, first-time customers are limited to Cash On Delivery [COD] or Company Check.

After establishing a satisfactory payment history, customers may become eligible for credit terms.

Customers will be notified of their credit approval status by email.

Credit Application Submission

Please review your application carefully before submitting.

All required information and applicable supporting documents must be provided before your application can be reviewed. Once submitted, your application will be reviewed by Silverback Concrete.

Please allow approximately 2–3 business days for processing.

You will be notified by email regarding your credit approval status.

Reservation of Rights

Silverback Concrete reserves the right to approve, modify, suspend, or deny credit at its sole discretion.

Credit applications may be denied for reasons including, but not limited to:

  • Incomplete applications
  • Missing documentation
  • Unsatisfactory trade references
  • Unsatisfactory credit history
  • Inaccurate or misleading information
  • Internal credit review determinations

Customer Certification

Customer Agreement *
Authorized Signature (Type Full Name) *
Printed Name *
Title *
Company *
Date *