337 SOUTH BROADWAY
856-456-4008
856-456-0639 Fax
CREDIT APPLICATION AND PERSONAL GUARANTEE
Applicant’s Name Telephone
#
Fax # Cell Phone #
Address
City State Zip
Type of Business Established
Since Proprship__ Ptnr. Corp
Credit Line Requested__________________
Principals And/ or Officers
Name Title Social
Security #
Address City State Zip Own / Rent
Name Title Social
Security #
Address City State Zip Own / Rent
Financial Information
Bank Name Telephone
# Acct.
#
Address City State Zip
Trade Reference (Please provide fax’s #)
Name Address City State Zip
Telephone # Fax
#
Name Address City State Zip
Telephone # Fax
#
Name Address City State Zip
Telephone
# Fax
#
I/ We certify that
the above information is true and correct and I/ We agree to pay this account
in accordance
with your credit terms. I/We authorize Gloucester Plumb. Supply
to verify this information and / or obtain additional information by securing
data from a credit-reporting agency.
I//We understand that all past due balances
will be subject to a 1 % service charge per month. I/ We further agree to pay 25% collection
charge in the event of default, if the account is placed with an attorney of
bonded collection agency.
Signature
(Owner or President/ No Title
Please)
Personal Guarantee
In consideration for the
credit extended in the undersigned hereby guarantees and agrees to be liable
for all indebtedness incurred. I/We authorize
Gloucester Plbg. Supply, to verify and obtain additional information by
securing data indebtedness incurred.
I/We authorize Gloucester Plbg Supply to verify and / or obtain
additional information by securing data from a credit-reporting agency. I/We further agree to pay a 25% collection
charge in the event of default, if the account is placed with an attorney or
bonded collection agency. (Must Be Signed By Owner Or
President No Title After Signature.)
Signature Date