GC Account Credit Activation Form

GC Account Credit Activation Form
Date*

MonthDayYear
Salesperson
Branch Location*
Legal Name*

First NameLast Name
Business Phone Number*
Address*
Email*
example@example.com
City/State/Zip*

Street Address

Street Address Line 2

CityState

Zip Code
Business Structure*

CorporationSole ProprietorshipPartnershipLLCLP
Federal Tax ID*
Name of Partners, Owners or Corporate Officers
Name*

First NameLast Name
Address*
Email*
example@example.com
City/State/Zip*

Street Address

Street Address Line 2

CityState

Zip Code
Social Security Number
Date of Birth*

MonthDayYear
Drivers License
D.L #
Name

First NameLast Name
Address
Email
example@example.com
City/State/Zip

Street Address

Street Address Line 2

CityState

Zip Code
Social Security Number
Date of Birth

MonthDayYear
Drivers License
D.L #
Ordering and Billing Information
Purchase Order Required*

YesNo
Payment Method*

ACH (preferred)CheckOther
Accounts Payable Supervisor*
Email*
example@example.com
Send Invoices To: *** e-mail address for billing purposes*
can list more than one
Credit Line Desired: $*
Location of Project/Property
Property Name*
Number of Units*
Year Built*
Property Address*

Street Address

Street Address Line 2

CityState

Zip Code
Name of Property Owner*
Owner Phone Number
Owner Address*

Street Address

Street Address Line 2

CityState

Zip Code
Trade References
Company Name*
Contact*
Phone Number
Email*
example@example.com
Company Name
Contact
Phone Number
Email
example@example.com
Bank Reference
Bank Name*
Account Number*
Contact*
Phone Number*
Bank Address*

Street Address

Street Address Line 2

CityState

Zip Code
Upon the earlier of (a) the date indicated on this account activation form or (b) my (our) acceptance of services or goods from Impact Floors of Texas, LLC (Impact Floors), I hereby agree and represent as follows: (i) if I am delivering this account activation form on behalf of a company or other legal entity, I have the authority to bind such entity to the terms and conditions of this form, (ii) the information furnished on this form is true and correct in all respects, (iii) I (we) hereby deliver this form to Impact Floors, including, without limitation, for the purpose of obtaining a credit account with Impact Floors and Impact Floors may rely on all information set forth herein, (iv) I am (we are) authorized to bind the applicable owner(s) of the property or properties to which the goods and services contemplated hereunder relate, including with respect to any and all purchases or orders for goods or services made from Impact Floors related to such property or properties, (v) I (we) authorize any person having information related to the management company or the applicable owner(s) to release financial information as credit reports to Impact Floors.
Date*

MonthDayYear
Date
Title*
Signature*

Clear
Printed Name*
I (we) further agree and acknowledge: (i) that all invoices shall be payable to Impact Floors at 2325 E. Belt Line Road Suite 200, Carrollton, Texas 75006, net 30 days of the invoice date, payable by check or ACH unless otherwise agreed in writing by Impact Floors, (ii) to pay interest at the lesser of (a) 18% per annum or (b) the maximum interest rate permitted by applicable law on all invoices not paid within 30 days of the invoice date, (iii) I (we) shall defend, indemnify, reimburse, and hold harmless Impact Floors from any and all losses, damages, fees, costs and expenses, including reasonable attorneys’ fees (including without limitation), fee costs and expenses related to collection of amounts outstanding or the enforcement of the terms hereof, including issuing demand letters and filing mechanics liens); (iv) performable in the terms of this account activation form or any matter arising hereunder or in connection with the goods and services contemplated hereby shall be Dallas County, Texas, (v) account activation will not be complete until I (we) have signed and delivered this account activation form, and (vi) I (we) have the authority to act as agent on behalf of the owner(s) of the property or properties to which the goods and services contemplated hereunder relate, including to bind such owner(s) to the terms and conditions hereof in all respects.
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Date*

MonthDayYear
Date
Title*
Signature*

Clear
Printed Name*
Should be Empty:

GC Account Credit Activation Form

Name of Partners, Owners or Corporate Officers

Ordering and Billing Information

Location of Project/Property

Trade References

Bank Reference