Business Credit Reports

Company Information

Company Name

Address

City

State/Province

Zip/Postal Code

Country

Phone

FEIN

D&B DUNS #

Type of Business

In Business Since

Legal Form (Corporation, Partnership, or Proprietorship)

State or Providence which Business was organized

If Division/Subsidiary, Name of Parent Company

In Business Since

Name of Company Principal Responsible for Business Transactions

Title

Have you ever filed for Bankruptcy? (Yes or No)

If yes, state when and where

Sales Person

Contact Information

First Name

Last Name

Title

Phone

General Information

Customer Name

Billing Address

Billing City

Billing State

Billing Zip Code

Office Phone #

Office Fax #

Accounts Payable Contact Information

Contact

Phone

Fax

Purchasing/Ordering Information

Order Contact

Order Phone #

Order Email

Delivery Information: Site 1

Address

City

State

Zip Code

Delivery Contact

Delivery Phone #

Delivery Information: Site 2

Address

City

State

Zip Code

Delivery Contact

Delivery Phone #

Bank Reference #1

Institution Name

Account #'s

Address

Phone

Bank Reference #2

Institution Name

Account #'s

Address

Phone

Credit Reference #1

Company Name

Contact Name

Address

Phone

Credit Reference #2

Company Name

Contact Name

Address

Phone

Credit Reference #3

Company Name

Contact Name

Address

Phone

Request

Requested Amount

Comments (400 characters max)

Supporting Documentation

Please upload copies of any sales tax exemption certificates you may have.

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Uploaded Documents

Terms

I agree and understand that a finance charge of 1.5% per month will be charged on any past due balances of 30 days or more. I agree and understand that in the event these amounts are not paid in full within 60 days from the date on which the same become due, GMCO Corporation may assign the same for collection. I agree to pay all costs including reasonable attorney’s fees necessary to collect the same. I acknowledge and agree that any transactions between GMCO Corporation and me will be governed by and construed in accordance with the substantive laws of the States of Arizona, Colorado, Idaho, Nebraska, New Mexico, Texas, Utah, Washington, and Wyoming.

Notwithstanding anything to the contrary, GMCO Corporation may at any time in its sole discretion, without notice or demand, refuse to ship or deliver products to any customer. GMCO Corporation may declare the entire balance of any account immediately due and payable if such account becomes past due. Further, GMCO Corporation may require any customer to pay cash in advance or may deny further credit for service or product if a condition occurs in which GMCO Corporation’s opinion could affect any customer’s ability to meet payment obligations. I guarantee the above information is true and accurate to the best of my knowledge and belief. I further authorize my creditors listed above to disclose to GMCO Corporation any and all information they may have gathered or constructed concerning my financial position and dealings, including cash flow budgets, financial statements, payment history, credit ratings, etc.

I accept the above terms.

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Submit the Request

By clicking 'Submit', I/We authorize GMCO Corporation or its agent to obtain a credit report for the purpose of establishing, maintaining or enforcing a credit relationship. Upon approval of credit, I/We agree to pay our account according to the terms granted and I/We acknowledge that I/We have read and fully understand this application.

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