Landscape Recycling Center Charge Application Form - City Of Urbana printable pdf download

CITY OF URBANA

LANDSCAPE RECYCLING CENTER

CHARGE APPLICATION

GENERAL INFORMATION

Name of Business: ____________________________________________________________________________________

Mailing Address: _______________________________________City, State, Zip____________________________________

Owner: __________________________Contact Person:

______________________ Phone Number: _________________

BANK REFERENCES

Bank: __________________________ City: _____________________________

Account Number: __________________ Contact Person: ____________________ Phone Number: ___________________

CREDIT REFERENCES

Trade: __________________________ Address: _________________________

Contact Person: ___________________ Phone Number: ____________________

Trade: __________________________ Address: _________________________

Contact Person: ___________________ Phone Number: ____________________

AUTHORIZED SITE USERS (SIGNATURES)

Name ____________________________ Name ______________________________ Name __________________________

THE USER SHALL:

Assume full responsibility for credit extended on the basis of this agreement and to be responsible for all charges to his or her account unless he

or she notifies the City in writing prior to the charges being made to that account.

Pay all finance charges levied against his or her account. No finance charge will be added if the account is paid within thirty (30) days of the

billing date. The finance charge is computed by a periodic percentage rate of one percent (1%) which is equivalent to a maximum annual rate of

12%.

Pay monthly bills within thirty (30) days. If any monthly bill is not paid thirty (30) days from the date of billing, the account will be placed on a

cash only basis. If a monthly bill is not paid within sixty (60) days from the date of billing, the account will be placed on a no service basis. No

changes in account status will be considered until the past due amount, including finance charges, is paid in full, or a payment schedule has

been negotiated. The User further agrees that in the event of suit to collect the past due amount, including finance charges, the User shall pay

all reasonable attorney's fees and actual court costs.

The City of Urbana on behalf of an Intergovernmental Agreement between the City of Urbana and the City of Champaign operates the

LANDSCAPE RECYCLING CENTER.

This intergovernmental facility, its agents and/or employees make no guarantee or warranty of the products available at this facility and assume no

liability for any damages that may occur to persons or property while on the Site.

***Due to recent federal regulations regarding identity theft, we now require additional documentation for LRC charge accounts. Such items

include: Business card, business letterhead, or driver’s license with name & address matching the name & address on the account application.

OWNER SIGNATURE ______________________________________________________ DATE_______________________

Return Completed Form to: City of Urbana, Accounting Department, 400 South Vine St., Urbana, IL 61801

FOR CITY USE

Fax (217) 384-2370

References

checked________

(updated March 2009)

Account#_______

Landscape Recycling Center Charge Application Form - City Of Urbana