GBGI - Application for Credit

Application For Credit
Company Information
Company Name
DBA Name (If applicable)
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Fax
Please enter a valid phone number.Format: (000) 000-0000.
Company Structure
Date Company Established

MonthDayYear
Date
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is billing address the same as ship to address?
Ship To Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is ship to address a residential address?
Email(s) for Invoice Distribution
Company Contacts
Contact
Banking Institution
Bank Name
Bank Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Bank Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Business/Trade References
Trade Reference (3 minimum)
Upload File
Tax Exemption Form

Please Upload Valid Tax Exemption Form
Cancelof
Should be Empty: