Delta Industries, Inc.

Credit Application

Please enter the information requested and then click on the "Submit" button. Fields denoted with a red * are required.

*Have you, the applicant, the business or any of the officers or owners of the business filed bankruptcy?
Bank Reference

Established Trade/Credit Reference

Reference 1
Reference 2
Reference 3
*Do you have a construction loan?
Construction Loan
*Do you own this Property?
Owner Information
*Type of business:
Officer/Owner
Officer/Owner
Officer/Owner
*Are Purchase Orders Required?

Terms and Conditions

I or we certify that the above information and any related materials that I or we provide to Delta Industries, Inc. are true and correct.  I or we are furnishing such information to Delta Industries, Inc. for the purpose of inducing Delta Industries, Inc. to extend credit to the above-named applicant (“Applicant”).  By submitting this form, I or we confirm Applicant’s agreement that all sales are made pursuant and subject to Delta Industries, Inc.’s standard terms and conditions of sale.  Our terms require the balance of your account to be paid by the 25th day of each calendar month following the date of purchase.  Inc public projects notwithstanding our standard terms, if I or we fail to pay the balance of our account within 15 days of receiving payment from the project owner I or we agree to pay the company the penalty as described in the MCA 31-5-27, as amended.  Applicant also agrees (a) to pay all charges when due or be subject to a late payment charge of 1.5% per month on the past due balances, (b) that any balance owed is due in full upon default or violation of terms, (c) to pay all collection costs including reasonable attorneys’ fees and expenses, (d) applicable Sales Tax will be added to all sales unless we’re furnished with a valid Exemption Sales Tax Certificate, (e) to supply you an accurate legal description of the real property upon which all materials and supplies will be used and installed, (f) to pay to you the cost of preparation and filing all notices of material men’s lien and stop notices, (g) that you shall have a lien, securing all amounts due under this application, on all real estate to which your materials are delivered and use; (h) waiver by you and default or provision of this agreement shall not be waivered or any other default or provision; (i) consent to Jurisdiction and Forum Selection, I or we agree that all auctions or proceedings arising in connection with this application or to collect any amount due on the sale of any materials or services sold to us shall be tried and litigated exclusively in the State and Federal courts located in the County of Hinds, State of Mississippi.  This venue is intended by the parties to be mandatory and not permissive in nature, thereby precluding the possibility of litigation between the parties with respect to or arising out of any materials or services sold to us in any jurisdiction other than that specified in this paragraph.  Each party hereby waives any right it may have to assert the doctrine of forum non conveniens or similar doctrine or to object to venue with respect to any proceeding brought in accordance with this paragraph, and stipulates that the State and Federal courts located in the County of Hinds, State of Mississippi shall have in personam jurisdiction and venue over each of them for the purpose of litigating any dispute, controversy, or proceeding arising out of or related to this application or the collection of any amount due on the sale or any materials sold.  I or we hereby authorize Delta Industries, Inc. to contact our financial trade references (including those listed above) and any credit reporting agency, to obtain, verify and reverify credit information.

*Agreement