GFT Credit Application

Credit Application
Legal Business Name*
Doing Business As (DBA) Name:
Mailing/Physical Address*

Street Address

Street Address Line 2

CityState

Zip Code
Select a Branch Affiliation*
Is the Mailing/Physical Address the same as the Billing Address?*
Billing Address

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Name*

First NameLast Name
Our business is an:*

IndividualPartnershipCorporationGovernmentLLC
Dun and Bradstreet #
Country*
County
Owner's Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Fax #
Please enter a valid phone number.
Owner's Email*
example@example.com
Entity ID, Business, Filing, Charter, Control, Trade Registration Number, or Name Reservation*
Sales tax exemption status?*

Charge me sales taxResale (We will resell GFT parts/services to our customer)Government exempt
Tax Exemption Certificate #
Upload Tax Exemption Certificate -THIS IS REQUIRED TO COMPLETE THE SUBMISSION

Cancelof
Upload W-9 -THIS IS REQUIRED TO COMPLETE THE SUBMISSION*

Cancelof
Individual Responsible for Payment*

First NameLast Name
Phone*
Do you want your invoices/statements emailed?*
Email
example@example.com
Do you require a Purchase Order?*
Who is authorized to issue a PO?

First NameLast Name
Type of Business*
How long has business been established (years)?*
Name of Bank*
Bank City & State*

Street Address

Street Address Line 2

CityState

Zip Code
Bank Contact Person*

First NameLast Name
Acct #
Bank Phone*
Bank Fax
Please enter a valid phone number.
Amount of Credit Requested*
Items to be purchased:*

ServiceEquipmentConstruction
Trade References
1.) Business Name*
Contact Name*

First NameLast Name
Phone Number*
Fax Number
Please enter a valid phone number.
Email*
example@example.com
2.) Business Name*
Name*

First NameLast Name
Phone*
Fax Number
Please enter a valid phone number.
Email*
example@example.com
3.) Business Name*
Name*

First NameLast Name
Phone*
Fax Number
Please enter a valid phone number.
Email*
example@example.com
Have You Been a Principle in any Bankruptcy within the Last 7 Years? *
NOTE OF SPECIFIC TERMS UNDER WHICH THIS CREDIT ACCOUNT IS OPENED:

1 - All invoices are due and payable within the terms stated on each invoice.
2 - Delinquent invoices or statements shall bear interest from the date when due at the highest non-usurious rate permitted by applicable law.
3 - Customer agrees to pay, and Guardian Fueling Technologies shall be entitled to recover, all costs and expenses incurred relating to collection of delinquent accounts, including reasonable attorney's fees (including at trial, on appeal, and from any bankruptcy proceedings court costs, and collection agency fees.
Do you consent to collection of electronic signature on this document?*

YesNo
The undersigned represents and warrants to Guardian Fueling Technologies that he/she has read and understands allthe information and terms of this application and agreement, and that the information provided herein is current, true, and accurate
CORPORATE OFFICER OR OWNER SIGNATURE*

Clear
Title*
Date

MonthDayYear
Date
Name*

First NameLast Name
Personal Guaranty
I hereby accept the terms as stated above in this application for an open credit account with Guardian Fueling Technologies and do hereby personally guarantee. unconditionally and irrevocably. the due and prompt payment of all obligations and liabilities of customer to Guardian Fueling Technologies.
CORPORATE OFFICER OR OWNER AND PERSONAL GUARANTOR SIGNATURE

Clear
Title
Date

MonthDayYear
Date
Name

First NameLast Name
Should be Empty:

Credit Application

Trade References

Personal Guaranty