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11 i <br />El <br />Ci <br />0 <br />INDIAN RIVER COUNTY <br />SOLID WASTE DISPOSAL DISTRICT <br />CREDIT APPLICATION <br />Account Number: <br />1. Name <br />2. Type of Account: <br />a. Individual <br />3. Type of Surety: <br />a. Bond <br />b. Business <br />b. Cash <br />� q <br />4. Address: Telep;ione: <br />VM1 1 <br />Main office <br />Number Street City State <br />f I <br />Florida Office: <br />Telephone: <br />Number Street City State <br />Invoice & Charges to be Mailed to: <br />Telephone: <br />r; <br />Number Street City State <br />Owner or Responsible Party: <br />Telephone: <br />than 3 <br />years, <br />:i <br />Previous <br />Address: <br />I <br />: <br />ti <br />F <br />TyY<n' <br />+d: <br />Y <br />+ <br />y <br />.t F) <br />INDIAN RIVER COUNTY <br />SOLID WASTE DISPOSAL DISTRICT <br />CREDIT APPLICATION <br />Account Number: <br />1. Name <br />2. Type of Account: <br />a. Individual <br />3. Type of Surety: <br />a. Bond <br />b. Business <br />b. Cash <br />� q <br />4. Address: Telep;ione: <br />VM1 1 <br />Main office <br />Number Street City State <br />f I <br />Florida Office: <br />Telephone: <br />Number Street City State <br />Invoice & Charges to be Mailed to: <br />Telephone: <br />r; <br />Number Street City State <br />Owner or Responsible Party: <br />Telephone: <br />Number Street City State <br />(If less <br />than 3 <br />years, <br />show previous address) <br />Previous <br />Address: <br />I <br />: <br />Number Street City State <br />(If less <br />than 3 <br />years, <br />show previous address) <br />Previous <br />Address: <br />5. Number of trucks operated Number of years in business: _ <br />Total estimated monthly usage <br />PLI <br />6. Total estimated monthly tonnage <br />1 <br />7. License No, of trucks authorized to charge against account: <br />8. If not paid within 30 days, credit is stopped. <br />.20 - <br />EXHIBIT C <br />I <br />5. Number of trucks operated Number of years in business: _ <br />Total estimated monthly usage <br />PLI <br />6. Total estimated monthly tonnage <br />1 <br />7. License No, of trucks authorized to charge against account: <br />8. If not paid within 30 days, credit is stopped. <br />.20 - <br />EXHIBIT C <br />