Contractor Credit Application — Pettyjohn Materials

Business Information

Legal Business Name *

DBA / Trade Name

Business Type *

Years in Business *

Federal Tax ID (EIN)

Contractor License #

Business Address *

Business Phone *

Business Email *

Owner / Applicant Information

Full Name *

Title / Position

Cell Phone *

SSN (Last 4 digits)

Home Address

Credit Request

Requested Credit Limit *

Expected Monthly Volume

Primary Materials Needed

Type of Work / Projects

Bank Reference

Bank Name

Account Type

Bank Phone

Account # (Last 4)

Trade References

Please provide 2 suppliers or vendors you have credit accounts with.

Reference 1

Company Name

Phone

Contact Name

Reference 2

Company Name

Phone

Contact Name

Card on File

By providing a card on file, you authorize Pettyjohn Materials to charge your card for approved orders placed on your account. You will receive an invoice before any charge is processed.

Cardholder Name *

Card Type

⚠️ Do not enter your full card number here. Once approved, Pettyjohn Materials will contact you to securely collect card details via Stripe.

Agreement & Signature

The applicant certifies that all information provided is accurate and complete. Applicant authorizes Pettyjohn Materials to verify credit references and obtain credit reports. Applicant agrees that all invoices are due within 30 days of invoice date. Past due accounts are subject to a 1.5% monthly finance charge. Pettyjohn Materials reserves the right to modify or revoke credit terms at any time.

I certify that the information provided is accurate and I agree to the credit terms stated above. *

Printed Name *

Date *

✅

Application Submitted!

Thanks ! We've received your credit application and will be in touch within 1–2 business days to review your account.

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