NASCRETE Precision In Every Pour | 8747 Weems Rd, Manassas, VA 20110 (571) 602-4757 · asadnoor@nascreteusa.com nascreteusa.com |
Application date 2026-09-08 | Requested terms Net 30 | Credit requested | Est. monthly purchases |
1. Applicant information
Legal business name | DBA / trade name | ||
Business type | Nature of business | Date established | Years in business |
Federal Tax ID / EIN | Contractor license # | Sales tax exempt | Exemption / resale # |
2. Addresses & contacts
Physical street | |||
City | State | ZIP | |
Billing street Same as physical address | |||
Billing city | Billing state | Billing ZIP | |
Business phone | Fax | Email | |
Website | Purchase order required | ||
Accounts payable contact | AP phone | AP email | |
Purchasing / order contact | Order phone | Order email | |
3. Bank reference
Bank name | Branch | ||
Bank address | |||
Account number | Years with bank | Bank contact | Bank phone |
4. Trade references
| Company | Contact | Phone | Account # |
|---|---|---|---|
5. Principals / officers
| Name | Title | % Own | Phone | Home address |
|---|---|---|---|---|
6. Authorization & agreement
The undersigned certifies that the information in this application is true and complete, is authorized to apply on behalf of the Applicant, and authorizes NASCRETE to investigate creditworthiness, including contacting the bank and trade references listed and obtaining consumer or commercial credit reports as permitted by law. The Applicant agrees to NASCRETE’s Terms and Conditions, including payment of invoices within approved credit terms. Unless credit is established in writing, NASCRETE may require payment in full upon delivery or in advance. Past-due balances may incur finance charges, collection costs, and reasonable attorney fees as permitted by law, and NASCRETE may suspend credit privileges and future deliveries. This application is governed by the laws of the Commonwealth of Virginia. Any legal action shall be brought in the state or federal courts located in Prince William County, Virginia.
Credit investigation authorized No | NASCRETE terms accepted No |
Authorized signature | ||
Printed name | Title | Date 2026-09-08 |
7. Personal guarantee
Personal guarantee offered No |
No personal guarantee is included with this application.
8. Office use only — NASCRETE
Reviewed by | Date | Decision |
Approved credit limit | Approved terms | Account number |
Return completed applications to asadnoor@nascreteusa.com or 8747 Weems Rd, Manassas, VA 20110. Phone (571) 602-4757. Information is used only to evaluate and administer a commercial credit account and is not sold to third parties.