Commercial Business Waste

2.  
   
   
   

   3025 Landfill Road, Greenville, NC 27834  |  Telephone: (252) 902-3350 |  Fax: (252) 830-4690

   Solid Waste & Recycling Application/Agreement For Credit
    

4. Company Name*
5. Federal ID # or SSN*
7. Mailing Address*
9. Telephone #*
10. Email Address*
12. Credit Amount Requested $*
13. Business Type*
14. Est. Monthly Tonnage*
16. Guarantor(s) / Business Owners Names*
18. Persons Authorized to Sign for Charges / Sales*
20. Business Bank / Financial Institution Name*
22. Business Bank / Financial Institution Address*
24. Account #*
25. Account Type*

    1. Checking

    1. Savings

    1. Loan
27. Require three principle firms with whom you have established credit
29. Firm 1: Name, Contact, Telephone #, Email*
31. Firm 2: Name, Contact, Telephone #, Email*
33. Firm 3: Name, Contact, Telephone #, Email*
35. Electronic Signature Agreement*

    The above firm hereby makes application/agreement for credit and provides Pitt County the information contained herein, which is warranted true and correct, for the purpose of establishing credit with Pitt County Transfer Station for solid waste disposal fees. In consideration thereof, it is agreed and understood that:

    1. The undersigned is a guarantor agent of the applicant and is duly empowered to enter into and make binding decisions on its behalf. 
    2. Interest accrues on past due accounts over $50.00 at the rate of 1.5% after 30 days from the invoice date. 
    3. The applicant authorizes release of credit information from the above-listed references. 
    4. Pitt County is entitled to reasonable attorney’s fees and costs of litigation if it must file suit to collect outstanding balances.

    By checking the "I agree" box below, you agree and acknowledge that 

    • Your application will not be signed in the sense of a traditional paper document, 
    • By signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
37. Electronic Signature*
38. Date *
40. Title*
44. The fields below are for internal office use only.
46. Account #:
47. Credit Limit:
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit Submit and Print

* indicates a required field