CREDIT APPLICATION

Streamline your business activities by opening an account with Intermountain Concrete Specialties. Businesses with an ICS account enjoy excellent terms and a timely payment discount. Fill out the form below or download a copy of the forms below and fax them to 801-486-4520.

Please complete the following form in its entirety. Incomplete applications will not be processed.

Approximate Credit Line Seeking:
Legal Business Name:
Business Name Utilized (if different from above)
Billing Address:
Shipping Address:
City:
State:
Zip:
Telephone Number:
Fax Number:
Business License Number:
Form of Entity:
If DBA, DBA of whom:
If Other, Describe:
Principal Business Activity:
Date Started:
Contractor's License Number:
How long in business under present ownership?
Federal ID#:
Tax Exempt:
Tax Number:
Is this business a subsidiary/ affiliate of any other entity?
If yes, identify the entity:
Purchase Orders Required?
If so, are only specific individuals authorized to issue POs?
Name of authorized persons:

425 West 1700 South
Salt Lake City, Utah 84115

P: 801-486-5311
F: 801-486-4520

Thanks, John, We wish you the Best!

On January 29th, 2010 John Anderson Idaho Id Branch Manager retired after 20 memorable years................ (The Rest of the Story)

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