Girard RV

Basic Information:

COMPANY NAME:

Billing Details:

BILLING STREET:

BILLING CITY:

BILLING STATE:

BILLING ZIP:

Shipping Details:
Billing Address Shipping Address Are Same

SHIPPING STREET:

SHIPPING CITY:

SHIPPING STATE:

SHIPPING ZIP:

PHONE:

FAX:

IF BUSINESS IS INCORPORATED, UNDER LAWS OF WHAT STATE?:

ORGANIZATION: Sole Proprietor Partnership Corporation

TYPE OF BUSINESS:

RESALE #.:

YEAR ESTABLISHED:

AT PRESENT LOCATION SINCE:

NAME AND ADDRESS OF PROPRIETOR, PARTNERS, OR CORPORATE OFFICERS: Add more

1. Name:

Address:

Title:

BANK REFERENCE:

BANK:

Phone:

Address:

Fax:

City:

State:

Zip:

Account#:

TRADE REFERENCES: WE MUST HAVE COMPLETE ADDRESSES AND PHONE NUMBERS. Add more

1. Firm Name:

Phone:

Address:

Fax:

City:

State:

Zip:

Account Number:

Contact:

AMOUNT OF CREDIT LINE REQUESTED:

Amount of Credit Line Requested: $

AUTHORIZATION TO RELEASE CREDIT INFORMATION:

My Business Account Name:

Account Number(s):

Authorized Signature(s) on Account:

Title(s):

Date:

AGREEMENTS, TERMS AND CONDITIONS CONTINUED:

Date:

COMPANY NAME:

*SIGNATURE:

TITLE:

CONTINUING PERSONAL GUARANTY: Add more

1. SIGNED:

Are you married?: Yes No (If married, spouse must sign.)

SPOUSE:

ADDRESS:

Basic Information:

Billing Details:

Shipping Details: Billing Address Shipping Address Are Same

Billing Address Shipping Address Are Same

NAME AND ADDRESS OF PROPRIETOR, PARTNERS, OR CORPORATE OFFICERS: Add more

BANK REFERENCE:

TRADE REFERENCES: WE MUST HAVE COMPLETE ADDRESSES AND PHONE NUMBERS. Add more

AMOUNT OF CREDIT LINE REQUESTED:

AUTHORIZATION TO RELEASE CREDIT INFORMATION:

AGREEMENTS, TERMS AND CONDITIONS CONTINUED:

CONTINUING PERSONAL GUARANTY: Add more

Shipping Details:
Billing Address Shipping Address Are Same