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APPLICATION FOR CREDIT |
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*Please print this form and then fill it out, then fax it to us! We must have a signature* |
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BUSINESS NAME _________________________________________________________________________________________ STREET ADDRESS _________________________________________________________________________________________ P.O. BOX ______ P.O. BOX ZIP ______ EMAIL _____________ WEBSITE ADDRESS______________ CITY __________ STATE ____ ZIP _______ PHONE# ________________ FAX# ___________ TYPE OF BUSINESS _____________________________ DATE ESTABLISHED ________________ |
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OWNERSHIP - CHECK ONE BELOW |
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| THIS BUSINESS IS A CORPORATION (IF CHECKED, GIVE NAMES OF CORPORATE OFFICERS) | |
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NAME _______________________ TITLE ________________________________ NAME _______________________ TITLE ________________________________ STATE INCORPERATED IN______________ CORPORATION#____________________________ |
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| THIS BUSINESS IS A SOLE PROPRIETORSHIP (IF CHECKED, FILL OUT THE INFORMATION BELOW) | |
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OWNERS NAME __________________________ SSN _____________________________ STREET ADDRESS _________________________ CONTRACTOR LICENCE#_________________ CITY __________ STATE ____ ZIP _______ PHONE# ________________ FAX# ___________ |
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| THIS BUSINESS IS A PARTNERSHIP (IF CHECKED, FILL OUT THE INFORMATION BELOW) | |
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OWNERS NAME __________________________ SSN _____________________________ STREET ADDRESS ____________________________________________________________ CITY __________ STATE ____ ZIP _______ PHONE# ________________ FAX# ___________ |
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OWNERS NAME ____________________ SSN _____________________________ STREET ADDRESS ____________________________________________________________ CITY __________ STATE ____ ZIP _______ PHONE# ________________ FAX# ___________ |
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IF BILLS ARE PAID BY A PARENT COMPANY, FILL IN THE INFORMATION BELOW |
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PARENT COMPANY______________________________________________________________ STREET ADDRESS ______________________________________________________________ CITY __________ STATE ____ ZIP _______ PHONE# ________________ FAX# ___________ |
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BANK REFERENCES |
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SAVINGS NAME _______________________ ACCT# ____________________________ CHECKING BRANCH ________________________ LOAN STREET ADDRESS _____________________________ CITY __________ STATE ____ ZIP _______ PHONE# ________________ FAX# ___________ |
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SAVINGS NAME _______________________ ACCT# ____________________________ CHECKING BRANCH ________________________ LOAN STREET ADDRESS _____________________________ CITY __________ STATE ____ ZIP _______ PHONE# ________________ FAX# ____________ |
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| COMMERCIAL TRADE REFERENCES: GIVE ONLY NAMES OF THOSE YOU BUY FROM ON OPEN ACCOUNT. REFERENCES WILL NOT BE CONSIDERED VALID UNLESS FULL NAMES AND ADDRESSES ARE INCLUDED. PLEASE LIST A MINIMUM OF THREE. | |
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1. NAME __________________________________ STREET ADDRESS __________________________________ CITY __________ STATE ____ ZIP _______ PHONE# ________________ FAX# ___________ |
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2. NAME __________________________________ STREET ADDRESS __________________________________ CITY __________ STATE ____ ZIP _______ PHONE# ________________ FAX# ___________ |
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3. NAME __________________________________ STREET ADDRESS __________________________________ CITY __________ STATE ____ ZIP _______ PHONE# ________________ FAX# ___________ |
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4. NAME __________________________________ STREET ADDRESS __________________________________ CITY __________ STATE ____ ZIP _______ PHONE# ________________ FAX# ___________ |
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I authorize Genie Air Conditioning Inc. to obtain information about my accounts from the above listed banks and creditors. |
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Required Authorization Signature Below |
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| AMOUNT OF CREDIT DESIRED MONTHLY $______________________ | |
| RESALE PERMIT #________________ CLICK HERE TO FILL OUT RESALE FORM | |
| PURCHASE ORDER REQUIRED? YES NO | |
| BILLING INSTRUCTIONS ____________________________________________________________ | |
| SHOULD GENIE AIR APPROVE THIS APPLICATION, I/WE AGREE TO PAY FOR GOODS PURCHASED WITHIN 30 (THIRTY) DAYS OF INVOICE DATE. GENIE AIR IS AUTHORIZED TO RUN A CREDIT REPORT AND TO CONTACT ANY REFERENCES OR BANKS LISTED ABOVE. IT IS UNDERSTOOD THAT ANY INFORMATION OBTAINED WILL BE USED SOLELY FOR GRANTING CREDIT. SERVICE CHARGES AT THE HIGHEST RATE PERMITTED BY STATE LAW WILL BE APPLIED TO PAST DUE ACCOUNTS. SHOULD IT BECOME NECESSARY TO COLLECT THIS ACCOUNT THROUGH AN ATTORNEY, LEGAL PROCEEDINGS, OR OTHERWISE, THE UNDERSIGNED, INCLUDING ENDORSERS, PROMISE TO PAY ALL COSTS OF COLLECTION, INCLUDING REASONABLE ATTORNEYS FEES. IF THERE IS A LAWSUIT, CREDITOR AGREES TO SUBMIT TO THE JURISDICTION OF LOS ANGELES COUNTY, CITY OF VAN NUYS, STATE OF CALIFORNIA. | |
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BUSINESS NAME _________________________________________________________________________________________ STREET ADDRESS _________________________________________________________________________________________ P.O. BOX ______ P.O. BOX ZIP ______ EMAIL ___________________ URL________________ CITY __________ STATE ____ ZIP _______ PHONE# ________________ FAX# ___________ |
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TITLE _______________ |
SIGNATURE _____________________________ AUTHORIZED BUYER/ CO. OFFICER/ PARTNER |
Individual Personal GuaranteeRESIDING AT __________________________________________________FOR AND IN CONSIDERATION OF YOUR EXTENDING CREDIT TO ________________________________________________________(NAME OF COMPANY) (HEREIN AFTER REFERRED TO AS THE "COMPANY ") OF WHICH I AM _________________________(TITLE) HEREBY PERSONALLY GUARANTEE PAYMENT TO GENIE AIR CONDITIONING & HEATING INC. IN THE STATE OF CALIFORNIA FOR ANY OBLIGATION OF THE COMPANY. I HEREBY TO BIND MYSELF TO PAY GENIE AIR CONDITIONING ON DEMAND ANY SUM WHICH AGREE MAY BE DUE BY THE COMPANY WHENEVER THE COMPANY SHALL FAIL TO PAY THE SAME . IT IS UNDERSTOOD THAT THIS GUARANTY SHALL BE A CONTINUING AND IRREVOCABLE GUARANTY AND INDEMNITY FOR SUCH INDEBTEDNESS OF THE COMPANY. I HEREBY WAIVE NOTICE OF DEFAULT, NON-PAYMENT AND NOTICE THEREOF, AND CONSENT TO ANY MODIFICATION OR RENEWAL OF THE CREDIT AGREEMENT HEREIN GUARANTEED. Witness ______________________________ Guarantor ________________________ Signature ____________________________ Signature _________________________ Address______________________________ |