G54 Terms Application

Terms Application
3777 South 500 West

Salt Lake City, Utah 84115

801.263.3333

ar@g54.com
G54 Salesperson Name (if known)
Business Name:*
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone:*
Fax:
Email*
example@example.com
Business Type*

CorporationPartnershipSole Proprietorship
How Long Established? *
Type of Business*
Owner Contact Information:
Owner's Name:*
Owner's Email*
example@example.com
Owner's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owner's Phone:
Accounts Payable Contact Information:

(Invoices will be emailed to the email provided below when order is shipped)
AP Name:*
AP Phone:*
AP Email*
example@example.com
Other Contact Information:
Name:
Title
Email
example@example.com
Phone:
Tax Exemption

Please upload your State's Tax Exemption Certificate:
Browse Files

Cancelof
If Tax Liable please check the box below:

Tax Liable
Bank Reference:

(will be kept confidential)
Bank Name
Bank Phone
Bank Address
Bank Officer to Contact
Trade References:

(Must have at least 3 RESPONDING references)
#1 Name*
#1 Email*
example@example.com
#1 Phone #
#1 Account #
#2 Name*
#2 Email*
example@example.com
#2 Phone #
#2 Account #
#3 Name*
#3 Email*
example@example.com
#3 Phone #
#3 Account #
#4 Name
#4 Email
example@example.com
#4 Phone #
#4 Account #
TERMS AND CONDITIONS OF OPEN ACCOUNT

_____________________________________________________________

FIRST ORDER: COD, CREDIT CARD, OR ON APPROVED CREDIT

SUBSEQUENT ORDERS: Net 30 after credit has been established. Invoice amount is due 30 days from the date of the invoice. Failure to pay within 30 days may cause future orders to be delayed or the account placed on C.O.D. terms. Orders exceeding credit limit may be shipped C.O.D.

DISCLOSURE STATEMENT --- PLEASE READ CAREFULLY

_____________________________________________________________

Any line of credit extended is based on the information herein. An additional 1.5% per month interest charge will be charged on all amounts not paid within 30 days from date of invoice. This is an annual percentage of 18%. In the event of default, the undersigned agrees to pay interest accrued, collection costs of 50% of remaining balance and reasonable attorney fees. No terms of conditions hereof may be changed except by consent of Great Mountain West Supply.

The undersigned warrants that he/she has authority to execute this open account agreement and to bind said company to the terms contained herein.

I hereby authorize you or your agent to secure a credit report and agree to the release of credit information. This authorization shall be continuing without expiration and a photocopy or fax copy shall be given the same effect as the original for the purpose of obtaining credit.

I understand, acknowledge, and accept Great Mountain West Supply's terms & conditions of open account and certify that the information given herein is true and correct.
Signature*

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Title*
Company Name*
Date*

MonthDayYear
Date
Amount of Credit Requested
Without signing and dating the above, this credit application cannot be processed!
Personal Guarantee (optional)

______________________________________________________

In consideration of Great Mountain West Supply (hereinafter referred to as GMWS) extending credit hereunder, the under-signed, jointly and severally guarantee and promise to pay GMWS, on demand, any and all indebtedness of the above named applicant to GMWS. This is continuing guarantee, and the obligations created hereby are unaffected by any change in the terms of the original indebtedness between GMWS and the above named applicant.

I / We hereby authorize you or your agent to secure a credit report and agree to the release of credit information. This authorization shall be continuing without expiration and a photocopy or fax copy shall be given the same effect as the original for the purpose of obtaining credit.
Signature

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Date

MonthDayYear
Date
Should be Empty:

Terms Application

Owner Contact Information:

Accounts Payable Contact Information:

Other Contact Information:

Tax Exemption

Bank Reference:

Trade References: