Clone of GECS Credit Application

Application for Credit
Bypass

Yes
This application is to apply for NET 30 credit terms with Gary's East Coast Service, Inc.

Filling out this application does not automatically give credit approval.

Please allow 2-5 business days for processing. You will receive an email with approval or denial status.

If you need service immediately, please arrange for payment to be made available at the time of service.
Credit Application Contact

Please let us know who we should contact for Credit Application questions and approval status
Name*
Title
Email*
Phone*
If you have questions please contact service@garyseast.com or 203-922-1000
Utilize the "Save & Send" button to finish this application at a later time or forward it to another individual for completion.
Gary's East Coast Service, Inc.

91 Willenbrock Rd • Suite B-1 Box 5

Oxford CT 06488

203-922-1000 • www.garyseast.com

Business Information
Legal Company Name*
DBA
Business Category*
Other
Type of Business*
Established in the state of*
Month/Year Established*
Federal ID Number
D&B Number
Are you tax-exempt in CT, MA, or NY?*
Please upload your tax exempt form(s)

Please upload appropriate tax forms for each applicable state. See below for Tax-Exempt Requirements
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Tax-Exempt Requirements
To be set up as exempt from tax you must be registered as tax-exempt with the state you are looking to have service performed. Please see below for additional forms that may be required depending on the state and your company's exemption category.

Connecticut
- Qualifying Exempt Organizations - must upload a CERT-119 Form dated 3 years or less
- Govermental Agencies - must upload a CERT-134 Form dated 3 years or less
- Nonprofit Charitable Hospital, Nonprofit Nursing Home, Nonprofit Rest Home, or Nonprofit Residential Care Home - must upload a CERT-113 Form dated 3 years or less
- Sales and Use Resale - must upload a CT Sales & Use Form dated 3 years or less
Massachussetts
- Goverment Agencies and other Qualifying Exempt Organizations - must upload your ST-5 Form
- Sales and Use Resale - Must upload your ST-4 Form
New York
- Goverment Agencies and other Qualifying Exempt Organizations - must upload your exemption certificate
- Sales and Use Resale - Must upload ST-120 Form
Other Exemption Statuses

If your organization holds a tax exemption status other than what is listed above, please upload your certifcate for our review.

Business Owner Information
Please add all individuals, partners, owners and/or officer information*

Terms of Agreement
By signing this application, the undersigned agrees to the following:
1. Should Gary’s East Coast Service, Inc. approve this application,I/we agree to pay for all goods and services purchased within 30 days of the date of invoice.
2. Gary’s East Coast Service, Inc. is authorized to contact any trade references or bank references listed above. It is understood that any information so obtained will be used solely for granting credit.
3. Service charges at the highest rate permitted by state law will be applied to past-due accounts.
4. Should it become necessary to collect this account by legal proceeding or otherwise, the undersigned including endorsers, promise to pay all costs of collection, including a reasonable attorney’s fees.
An Owner, Partner, or Officer must sign
Signature*

First Name*   Last Name*

Title*   Date*
Signature
First Name
Last Name
Title
Date
Individual Personal Guarantee

Please fill out the fields below to populate the Personal Guarantee
Full Name
Social Security No.
Residing Street Address
Residing Town
Residing State
Title
Personal Guarantee

I, {fullName}, Social Security No. {socialSecurity}, residing at {residingStreet},{residingTown} in the state of {residingState} for and in consideration of Gary's East Coast Service, Inc. extending credit at my request to {legalCompany22} (Hereinafter referred to as the “company”), of which I am {title}, Hereby personally guarantee to you the payment of any obligation of the Company and I hereby agree to bind myself to pay Gary’s East Coast Service, Inc. on demand any sum which may become due to Gary’s East Coast Service, Inc. by the Company whenever the Company shall fail to pay the same. It is understood that this guarantee shall be a continuing and irrevocable guarantee and indemnity for such indebtedness of the Company. I do hereby waive notice of default, non-payment and notice thereof and consent to any modification or renewal of the credit agreement hereby guaranteed.
Signature Date

Individual Personal Guarantee
I,   First Name   Last Name  , Social Security No.   Social Security Number

residing at   Street Address   Address Line 2   City  in the state of State   , Zip for and in consideration of Gary's East Coast Service, Inc. extending credit at my request to {legalCompany22} (Hereinafter referred to as the “company”), of which I am Title Hereby personally guarantee to you the payment of any obligation of the Company and I hereby agree to bind myself to pay Gary’s East Coast Service, Inc. on demand any sum which may become due to Gary’s East Coast Service, Inc. by the Company whenever the Company shall fail to pay the same. It is understood that this guarantee shall be a continuing and irrevocable guarantee and indemnity for such indebtedness of the Company. I do hereby waive notice of default, non-payment and notice thereof and consent to any modification or renewal of the credit agreement hereby guaranteed.

Signature   Date
Add Additional Guarantor
I,   First Name   Last Name  , Social Security No.   Social Security Number

residing at   Street Address   Address Line 2   City  in the state of State   , Zip for and in consideration of Gary's East Coast Service, Inc. extending credit at my

request to {legalCompany22} (Hereinafter referred to as the “company”), of which I am Title Hereby personally guarantee to you the payment of any obligation of the Company and I hereby agree to bind myself to pay Gary’s East Coast Service, Inc. on demand any sum which may become due to Gary’s East Coast Service, Inc. by the Company whenever the Company shall fail to pay the same. It is understood that this guarantee shall be a continuing and irrevocable guarantee and indemnity for such indebtedness of the Company. I do hereby waive notice of default, non-payment and notice thereof and consent to any modification or renewal of the credit agreement hereby guaranteed.

Signature   Date

Credit References

Please either upload your company's Credit Reference Sheet or Manually enter your company's credit references by selecting from the two options below
Upload Your Company's Credit Reference Sheet
Manually Enter Information
Please upload your company's Credit Reference Sheet

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Service Location Information
Manually Enter Service Location InformationOther
Upload a List of Service Locations
Service Location(s)
Please upload a list of Service Locations with their Contact Information

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Please add any site information that our dispatchers or technicians may need

Invoicing Information
Bill to Address*
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Invoice Method*
Email Invoices
Please add any emails that should receive a copy of the invoice
Do you require a PO or Authorization Number for service calls placed to Gary's East Coast Service?*
Please inform us of any NTE or other Invoicing requirements
Service Agreements
I do not have a Service Agreement, Additional Requirements, or Contracts for Gary's East Coast Service, Inc. to reviewI do have a Service Agreement, Additional Requirements, or Contracts for Gary's East Coast Service, Inc. to reviewOther
If applicable, please upload any Service Agreements, Requirements or Contracts that you may require of Gary's East Coast Service for our review

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Accounts Payable Information
Name*
Title*
Email*
Phone*
Additional Information

Review and Submit Application for Credit
Please allow 2-5 business days for processing. You will receive an email with approval or denial status.

Questions can be sent to service@garyseast.com or 203-922-1000
Please verify that you are human*
Gary's East Coast Service, Inc.

91 Willenbrock Rd • Suite B-1 Box 5

Oxford CT 06488

203-922-1000 • www.garyseast.com
Should be Empty:

	Name	Address	City, State, Zip	Phone	Email	Account #
Bank Reference
Trade Reference 1
Trade Reference 2
Trade Reference 3

Application for Credit

Credit Application Contact

Business Information

Business Owner Information

Terms of Agreement

An Owner, Partner, or Officer must sign

Individual Personal Guarantee

Individual Personal Guarantee

Credit References

Service Location Information

Invoicing Information

Email Invoices

Service Agreements

Accounts Payable Information

Review and Submit Application for Credit