Western National may obtain a credit report about the Applicant including its Owner(s)
and Owners' spouses in order to confirm the information provided in this application
and obtain information about Applicant's credit history. For new applicants, complete
and sign the General Indemnity Agreement.
*This application is NOT INTENDED for use in connection with Subdivision or Site Improvement,
Completion, Environmental, Hazardous Materials, Design, Design Build, Consulting, Projects
Performed In or Under Water, Computer Programming, Systems Integration, Training or Projects
of a Unique Nature.
Any person who knowingly and with intent to defraud any insurance company or person files an
application containing any materially false information or conceals, for the purpose of misleading,
information concerning any fact material thereto commits a fraudulent insurance act, which is a crime
under applicable law. The applicants and indemnitors certify the truth of all statements in the application
and authorize the Company to verify this information and to obtain additional information from any source
including obtaining a credit report.
Provide the company's most recent fiscal year-end financial statements along with the most
recent corporate tax return. If the latest fiscal year financial statement is more than 6
months old, then also provide a current interim financial statement. An aging of accounts
receivable schedule may be requested if the amount is relevant.
Provide a current schedule of uncompleted projects as of the same date as the most recent
fiscal year-end financial statement.
Provide a copy of each owner's personal financial statement and most recent personal tax return.
The personal financial statements must be current as of the last six months.
Please complete Western National’s Bank/Credit Reference Form or supply copies of corporate
bank line of credit details with supporting documents and applicant’s business and personal
7220 N. 16th Street
Phoenix, AZ 85020