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Online Credit Application Form

Thank you for your interest in our dealership program. Please fill out ALL fields with valid information. Incomplete forms and invalid information can result in delays and/or denials.

Mailing Address

Company Name

Address

City

State

Zip

Email (Purchasing/Sales Contact)

Email (Repeat for security)

AP Email

Phone

Fax

Billing/Shipping Address

Contact Name

Contact Email

Billing Address

 Same as Mailing Address

Address

City

State

Zip

Phone

Fax

Shipping Address

 Same as Mailing Address

Address

City

State

Zip

Company Information

Business Type (Choose One):  Corporation        Partnership        Individual

Years in Business

Principal's Name

Number of Employees

Principal's Home Phone

Principal's Home Address

City

State

Zip

Business References

1. Company Name

Phone

Fax

Email

Address

City

State

Zip


2. Company Name

Phone

Fax

Email

Address

City

State

Zip


3. Company Name

Phone

Fax

Email

Address

City

State

Zip


Bank Name

Bank Account#

Phone

Fax

Email

Address

City

State

Zip

Digital Signature and Agreement

By signing and submitting this application, I certify that all information on this application is correct; that I personally assume all responsibility for all charges made to my company’s account; that I personally guarantee the full performance of the firm, whether a corporation, partnership, or otherwise, of all debts and obligations to GlassCraft Door Corporation, and agree to pay within the terms; and I understand that if legal proceedings become necessary to collect monies owed, all court cost, legal fees and attorney fees, an interest of 18% per annum will be added to the amount owed GlasCraft Door Corporation, and will be paid by our firm, and I agree that the venue of these legal proceedings shall be Houston, Harris County, Texas.

In addition, I authorize the above firms to release to GlassCraft Door Corporation, any information required for the establishment of credit.

 I have read and understand my responsibilities.

Authorized Name

Company Name

Job Title

 

Date

 

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GlassCraft Door Company