Credit Application Form

    Date:
    Federal ID #:
    Business / Individual Name:
    Social Security #:
    Select One:


    Delivery Address:





    Mailing Address





    Phone No
    Fax No

    Accounts Payable Contact

    Name
    Phone No
    1. First


    2. Second


    3. Third


    Business / Individual Information
    Years in Business::
    Years at Present Address:
    No. of Locations:
    Type of Business:
    Credit Line Desired:
    Are Purchases for Resale?:

    If yes, please fill out the Resale Certificate Form in addition to this document.

    Credit References

    1.First


    2.Second


    3.Third


    Bank References

    1.First



    Select One

    2.Second



    Select One


    Account Agreement

    I HEREBY MAKE APPLICATION FOR AN ACCOUNT WITH GUNDIE’S INC. WITH THE UNDERSTANDING THAT EACH STATEMENT IS TO BE PAID IN FULL ON OR BEFORE THE 10TH OF THE MONTH FOLLOWING DATE OF PURCHASE. THE BALANCE DUE AFTER 30 DAYS WILL BEAR INTEREST AT THE RATE OF 1.5% PER MONTH. OVERDUE ACCOUNTS WILL BE C.O.D. UNTIL UNPAID BALANCE IS PAID IN FULL.

    APPLICANT’S SIGNATURE ATTESTS FINANCIAL RESPONSIBILITY, ABILITY AND WILLINGNESS TO PAY INVOICES IN ACCORDANCE WITH AGREED TERMS. IF GUNDIE’S INC. EMPLOYS A COLLECTION SERVICE OR ATTORNEY TO COLLECT OF SAID ACCOUNT, APPLICANT COVENANTS AND AGREES TO PAY COLLECTION COSTS AND ATTORNEY FEES.

    APPLICANT HEREIN, WARRANTS AND REPRESENTS THAT ALL STATEMENTS MADE HEREIN ARE TRUE AND CORRECT AND AGREES TO PAY HIS ACCOUNT IN ACCORDANCE WITH THE TERMS AS SET FORTH HEREIN.

    TERMS AND CONDITIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE.

    Business / Individual Name:
    Date:
    Title: