Mobile Concrete, Inc.
	P.O. Box 1254
	Jesup, GA 31598-1254
	Serving
	Brantley, Glynn, Liberty, Long, McIntosh, Tatnall & Wayne Counties
(912) 427-2330 Corporate Office Phone					(912) 427-2300 Fax
Open Credit Application
			Applicant
			Mailing Address
	City		State		Zip
	Contact Person		Telephone		Fax
	Person(s) authorized to sign for materials
	Purchase Order required? Circle One Yes  /  No
	Type of Organization
	Individual		Partnership		Corporation
	Credit References
	(Please include account # if possible)
	Name		Address		Phone/Account #
1.)
2.)
3.)
Personal Guarantee
In consideration of the extension of credit to the above named applicant, we personally and indvidually guarantee payment to Mobile Concrete, Inc. any and all current and future indebtedness, including payment on demand. This  agreement will remain in effect until written notice of its' termination is received by Mobile Concrete, Inc. In the event this account becomes past due, purchaser (applicant) agrees to pay reasonable fees incurred by suit or otherwise.
	Signed this _____ day of ____________, 20___ :
	*Mobile Concrete, Inc. terms are net 30 days
	***Office Use Only***
	Name		High Credit		Terms/Method of Payment