CREDIT APPLICATION AND ACCOUNT AGREEMENT

Name of Business*

DBA

("Doing Business As") is when a person or corporation decides to do business under a name different than its legal name

Type of Business*

CorporationDate IncorporatedPartnershipIndividual

Company Type*

Credit Limit Requested*

Telephone*

Phone Number

Fax

DUNS Number*

Federal Tax ID Number*

WEB Address

Sales Tax Exempt?*

Yes (Please provide a copy of your Sales Tax Exempt Certificate below)No (Your order may be charged sales tax if shipping to an applicable state)

Please Upload Your Completed Tax Exempt Form*

Browse Files

Bill-To Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Ship-To Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name*

First NameLast Name

Phone Number*

Phone Number

Email*

example@example.com

Invoice Submission Method*

E-mailUpload via portal

Email Address to send payment inquiries*

example@example.com

Shipping Method*

Prepaid and AddCollect (Must include Carrier and Collect number below)

Carrier

Collect Number

Carrier

Collect Number

Name*

First NameLast Name

Title*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name

First NameLast Name

Title

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name

First NameLast Name

Title

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Bank*

Phone Number*

Phone Number

Officer's Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Do you have trade reference documents?*

Yes (Please provide a copy of your trade reference documents with email addresses. Having no email address could delay the process)No (Please complete trade reference section below)

Trade Reference Documents

Browse Files

Email addresses for trade references must be provided

Business Name

Contact Name

Phone Number

Email

example@example.com

Business Name

Contact Name

Phone Number

Email

example@example.com

Business Name

Contact Name

Phone Number

Email

example@example.com

Gibson Engineering contact*

Provide the name of the Gibson Engineering contact you are working with

Authorization for release of credit information*

Date

In consideration of any extension of credit to (the undersigned) by Gibson Engineering Company (GEC), including that of charging to the account of the undersigned for purchases by it from GEC, it is agreed by the undersigned that any and all invoices, purchases, charges and debts of the undersigned owed to GEC will be subject to and governed by the credit terms of GEC then in existence, which credit terms presently include the following, which terms are specifically agreed to by the undersigned, to-wit. All invoices, charges, debts and sums owed by the undersigned to GEC are due in full within thirty (30) days of the purchase by the undersigned from GEC of the merchandise which gives rise to such debt(s),with interest and/or service charges on any balance due of one and on-half (1-1/2%) percent per month (18%) per annum commencing thirty (30) days after such purchase.
It is understood that any credit and/or agreements relative thereto extended by GEC to the undersigned may be terminated at any time by GEC without notice and without cause, any such notice or demand being waived, and any such termination not affecting the rights of GEC against the undersigned or any guarantor under this agreement or against any merchandise sold to the undersigned. It is further understood that no obligation exists on the part of GEC to extend any credit on account or any other basis to the undersigned now or in the future pursuant to this or any other agreement between the undersigned and GEC.

Company*

Officer Name*

Officer Signature*

Date*

Date

CREDIT APPLICATION AND ACCOUNT AGREEMENT

A/P Contact

FULL NAME AND ADDRESS OF OWNERS, PARTNERS OR CORPORATION OFFICERS

BANK REFERNECES

TRADE REFERENCES

ACCEPTED, AGREED AND APPROVED