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APPLICATION FOR CREDIT

SHELBY CONCRETE, INC.

SHELBY BLOCK / BUILDERS SUPPLY BLOCK. LLC

BALDWIN CONCRETE / CHILTON PAVING& ASPHALT

PO BOX 509

SAGINAW,AL. 35137

(205)663-6800 FAX (205)378-1011

Applicant's Company Name Or Personal Name (if individual)

Street Address

City State Zip

Billing Address

City State Zip

Office Fax Beeper

Cellular Nextel ID# Southern Linc

E-Mail Type of Buisness Year Started

Tax Exempt (Y/N)___(if yes, please enclose copy of certificate- REQUIRED)

Are Purchase Order #'s Required? (Y/N)___ Accounts Payable Contact

Name of Owners,Partners or Officers

Name Title Home Phone

Residences address Social Sec.#

Credit Reference 1

Name Phone#

Address

Credit References 2

Name Phone#

Address

Primary Banks for Checking and Construction Loans (please include telephone numbers)

In exchange for sale of material by Shelby Concrete Inc. (Shelby) to credit applicant, I (we) the undersigned guarantee without exception to Shelby, payment of all amounts due by credit applicant. Default in such payment shall constitute breach of this contract and Shelby may proceed with any legal remedy without further notice. If default is made in payment when installment is due, then all remaining installments shall become due and payable at once. All signers, endorsers, and parties to this instruments hereby waive demand, protest and notice of nonpayment, and agree to pay all cost of collection, including but not limited to attorney's fees, court cost and any other costs incurring. Credit applicants also agree to waive all rights of exemption which they have or may have charged and collected a late charge of 18% per annum for any invoices not paid within 30 days from invoice date

The undersigned individual who is either a principal of credit applicant, a sole proprietorship, partnership, LLC or other, recognizes the his/hers individual credit history may be a factor in the evaluation of the credit history of the applicant,hereby consents to and authorizes the use of a time as may be needed, in the credit evaluation process.

Please Type Name Please Type Name

Signature_________________             Signature _________________

Date                                             Date                                              

The undersigned personal guarantor(s), recognizes the his/hers individual credit history may be a necessary factor in the evaluation of this personal guarantee, hereby consents to and authorizes the use of a consumer credit report on the undersigned, by the above name business credit grantor, from time as may be needed, in the credit evaluation process.

Please Type Name Please Type Name

Signature_________________             Signature _________________

Social Sec.#            Social Sec.# 

Date                           Date