Your Next Concrete Project With Modern Concrete & Materials

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Planning residential or commercial construction? A new build, a remodel or an addition? We’re just a pour away from getting your project started!

Complete the New Account Application

Name(Required)

First Last

Email(Required)

Phone(Required)

Company Name(Required)

Fax Number

Optional

Invoices and statements are sent via email. If an email is not provided, all correspondences will be mailed.

Billing Email

Optional

PO Required(Required)

Tax Exempt?

Yes

Please attach your tax exemption certificate(Required)

Max. file size: 300 MB.

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Type of Business(Required)

Number of Years in Business(Required)

Number of Years at this Address(Required)

Business Classification(Required)

If Other, Please Specify

Owner's Name(Required)

First Last

Owner's Phone Number(Required)

Owner's Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Bank Name(Required)

Bank Point of Contact(Required)

Bank Phone Number(Required)

Trade References

Please list only commercial references with open accounts

First Reference Name(Required)

First Last

First Reference Phone(Required)

First Reference Email(Required)

First Reference Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a Second Reference?

Yes

Second Reference Name(Required)

First Last

Second Reference Phone(Required)

Second Reference Email(Required)

Second Reference Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a Third Reference?

Yes

Third Reference Name(Required)

First Last

Third Reference Phone(Required)

Third Reference Email(Required)

Third Reference Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a Fourth Reference?

Yes

Fourth Reference Name(Required)

First Last

Fourth Reference Phone(Required)

Fourth Reference Email(Required)

Fourth Reference Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add a Fifth Reference?

Yes

Fifth Reference Name(Required)

First Last

Fifth Reference Phone(Required)

Fifth Reference Email(Required)

Fifth Reference Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Acknowledgement of Account Agreement and Terms

Modern Concrete & Materials, LLC Account Agreement and Terms

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Account Agreement and Terms

The company submitting this application agrees to the following conditions:

It is understood and agreed that the undersigned specifically consents to Modern Concrete & Materials, LLC investigating the undersigned’s credit history for the purpose of extending credit.
If credit is extended, the undersigned acknowledges that Modern Concrete & Materials, LLC credit terms are payment in full net thirty (30) days from the date of the invoice.
All sums are due and payable in the County of Jefferson at the mailing address of: P.O. Box 21577, Beaumont, TX 77720. In the event of a lawsuit, venue shall reside in the aforementioned County.
In the event the undersigned fails to timely pay any invoice, the undersigned agrees to pay a late fee to Modern Concrete & Materials, LLC on such delinquent invoice until same is fully paid, at the maximum rate allowed by the laws of the jurisdiction where the originating Modern Concrete & Materials, LLC branch is located.
The undersigned agrees that, with or without notice or demand, the undersigned shall reimburse Modern Concrete & Materials, LLC, for all expenses (including counsel fees) incurred by Modern Concrete & Materials, LLC in connection with any indebtedness of the application or the collection thereof.
The undersigned agrees fully and promptly to furnish to Modern Concrete & Materials, LLC information needed or requested by Modern Concrete & Materials, LLC for proper filing out and service of preliminary notices, under the mechanic’s lien laws.
This agreement shall be governed and construed by the laws of the STATE OF TEXAS. Customer consents to jurisdiction in the State and United State District Court, Eastern District, of Texas for resolution of all Collections. If any provision, or any part of any provision of this Agreement or the application thereof is the thereafter held invalid or unenforceable, the remainder of this Agreement shall not be affected thereby and to this end the provisions of this Agreement are declared severable.

By checking this box, you acknowledge and agree with the Modern Concrete & Materials, LLC Account Agreement and Terms.(Required)

I Agree

Acknowledgement of Guaranty

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Guaranty

In consideration of the extension of credit to the applicant named herein, the undersigned, jointly, severally and unconditionally guarantee and promise to pay all amounts now owing or which many hereinafter become owing by the applicant to Modern Concrete & Materials, LLC. This is a continuing guaranty and obligations arising hereunder shall not be affected by any change in terms of indebtedness, the extension of credit beyond amounts specified herein, a change in the term or time of payment, a change in the form of indebtedness, or the acceptance of security or collateral. Modern Concrete & Materials, LLC shall not be required to exhaust any remedies against applicant prior to exercising rights granted hereby.

The undersigned hereby waives (a) notice of acceptance of this guaranty and the extensions of credit by Modern Concrete & Materials, LLC to the applicant; (b) presentment and demand for paying of any indebtedness of the applicant; (c) protest and notice of dishonor or default to the undersigned with respect to any indebtedness of the applicant; (d) all other notices to which the undersigned might otherwise be entitled; (e) any demand for paying under the guaranty; (f) benefit of all exemptions and homestead laws; (g) all set-offs and counterclaims.

This is a guaranty of payment and not of collection and the undersigned further waives any right to require that any action be brought against the applicant of any other reason or to require that resort be had to any security.

The undersigned agrees that, with or without notice or demand, the undersigned shall reimburse Modern Concrete & Materials, LLC, to the extent that such reimbursement is not made by the applicant, for all expenses (including counsel fees) incurred by Modern Concrete & Materials, LLC in connection with any indebtedness of the applicant or the collection thereof, and will pay attorneys’ fees if this guaranty is placed with an attorney for enforcement or collection from the undersigned.

If any provision or part of any provision of this guaranty is in conflict with any applicable statute or rule of law then such provision, or part thereof, as the case may be, shall be deemed null and void to the extent that it may conflict therewith, but without invalidation the remaining provisions hereof or the remaining part of such.

By checking this box, you acknowledge and agree with the Modern Concrete & Materials, LLC Guaranty.(Required)

I Agree

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Your Next Concrete Project With Modern Concrete & Materials

Let’s Get Started

Complete the New Account Application

Trade References

Acknowledgement of Account Agreement and Terms

Account Agreement and Terms

Guaranty

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