Fillable CATAWBA COUNTY PERMIT CENTER CREDIT APPLICATION P.O. Box (Catawba County NC)

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CATAWBA COUNTY PERMIT CENTER CREDIT APPLICATION P.O. Box (Catawba County NC)

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Updated 2019-07-29 Page 1 of 3
CATAWBA COUNTY PERMIT CENTER CREDIT APPLICATION
P.O. Box 389, Newton, NC 28658
Phone 828-465-8160 | Fax 828-465-8962
Email: cindym@catawbacountync.gov or permitapps@catawbacountync.gov
New Account
Recent Paid Permit Number ____________________________________________________________
Full License Number(s) (i.e.U-12345)
License Holder Name
Business Name or Owner Name
Principal Name, if Business
*Social Security or
*Employer Identification Number (EIN)
*The Social Security Number of the License Holder and/or Business Owner, or the Corporate EIN if
applicable, will be used, in accordance with North Carolina General Statutes §132-1.10 and §105A-3, the
Debt Setoff Clearinghouse Program, for the purpose of garnishment should any debt owed to Catawba
County become delinquent. The disclosure of the Social Security Number is voluntary.
License Holder Signature
Print name
Signature
Mailing Address
Physical Address (Required)
E-mail Address
Phone Number Mobile Fax
Type of Invoicing Preference: (Check One) US Mail Electronic via Email
Type of Inspection Notification: Email: __________________________________________ and/ or
Text (phone number)__________________ phone Service Provider _______________________
Email address for Electronic Invoicing:
Please notify the Permit Center of any changes in license, business name, address, and phone
numbers or authorized signatures within 30 days of billing statement.
Application Completed By
Position
Signature Date
Signers other than the license holder are only allowed by written authorization on company
letterhead.
Updated 2019-07-29 Page 2 of 3
A bank reference and two (2) credit references are required or application will not be accepted.
Fax numbers are also required.
BANK REFERENCE INFORMATION
Name
Address (Mailing)
Contact Person
Phone Number Fax Number
**REQUIRED**
OFFICE USE
NOTES:
CREDIT REFERENCE INFORMATION
(Banks cannot be used as credit references)
Name
Address (Mailing)
Contact Person
Phone Number Fax Number
**REQUIRED**
OFFICE USE
NOTES:
CREDIT REFERENCE INFORMATION
Name
Address (Mailing)
Contact Person
Phone Number Fax Number
**REQUIRED**
Updated 2019-07-29 Page 3 of 3
OFFICE USE
NOTES:
Application Received By: _________________________________ Date: ______________________
Credit reference letter sent on: Re-sent on:
Approved or Disapproved: By: Date:
If disapproved, Reason:
If disapproved, notified applicant in writing on:
Attached copy of letter
Account Number Assigned By
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CATAWBA COUNTY PERMIT CENTER CREDIT APPLICATION P.O. Box (Catawba County NC)

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Completed 17 July 2020

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