GVM Ag Parts Catalog 2021

APPLICATION FOR ACCOUNT PLEASE COMPLETE ALL QUESTIONS (print or type). Also available online. NOTE: THIS APPLICATION WILL BE RETURNED IF NOT COMPLETED IN FULL.

Complete Business Name: ______________________________________________________________________________________________

(If incorporated, print exactly as shown on Corporate Charter)

Type of Business: _____________________________________________________________________________________________________

Number of Years in Business: _________________ Phone (Bus): (

) _____________________ Fax #: (

) ____________________

Street Address or Physical Location: _______________________________________________________________________________________

Billing Address: ______________________________________________________________________________________________________

Purchasing Agent: ______________________________________________ E-mail Address: _______________________________________

CREDIT APPLICATION

Annual Sales: _________________________________________

Type of Organization:

❏ Corporation

Federal Tax I.D. Number: ______________________________________________________________________

❏ Partnership

Federal Tax I.D. Number: ______________________________________________________________________

❏ Individual

List of Complete Names of all Principals:

________________________ _______________________ _______________________________________ _____________________

Name

Title

Home Address

Social Security Number

________________________ _______________________ _______________________________________ _____________________

________________________ _______________________ _______________________________________ _____________________

Credit References: Banks (include personal bank if proprietorship or partnership):

1. ______________________ ________________________________________ _______________________ (

)________________

Name

Complete Address

Officer to Contact

Telephone Number

2. ______________________ ________________________________________ _______________________ (

)________________

Equipment dealers and other suppliers that have extended credit to you ( must include fax number and/or email):

3. ______________________ _________________________________________________________________________________________

Name of Suppliers or Finance Co.

Complete Address

( ____ ) _____________________ ( ____ ) ________________________ ________________________________________________

Telephone Number

Fax Number Required

Email Required

4. ______________________ _________________________________________________________________________________________

Name of Suppliers or Finance Co.

Complete Address

( ____ ) _____________________ ( ____ ) ________________________ ________________________________________________

Telephone

Fax Number Required

Email Required

5. ______________________ _________________________________________________________________________________________

Name of Suppliers or Finance Co.

Complete Address

( ____ ) _____________________ ( ____ ) ________________________ ________________________________________________

Telephone

Fax Number Required

Email Required

6. ______________________ _________________________________________________________________________________________

Name of Suppliers or Finance Co.

Complete Address

( ____ ) _____________________ ( ____ ) ________________________ ________________________________________________

Telephone

Fax Number Required

Email Required

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