Credit Application

Thank you for your interest in G&S Concrete Cutting. To assist us in your request for credit, please complete this online application

Account Name:*

Parent Co.(if subsidiary):

Office Address:

City/State/Zip:

G&S Account Number:*

IP Address:
The present office at this location since:

Type of business:

In business since:

Type of ownership:

Sole Ownership:

Partnership:

LLC:	Incorporated in: (STATE)

Owner´s Name: *

Residential Address:

Home City/State/Zip:

Phone Number (Residence):

Social Security Number: *

Title: *

Date:

Trade References:

Reference #1:

Name:

Fax Number:

Phone:

Reference #2:

Name::

Fax Number:

Phone:

Reference #3:

Name:

Fax Number:

Phone:

I agree that all the above information is correct, and I (we) authorize G&S Concrete Cutting to make any credit inquiries.

Personal Guarantee

The undernamed agree(s) to guarantee the payment of all monies due to G&S Concrete Cutting until this guarantee has been withdrawn in writing. Also, the undernamed Guarantor(s) agree(s) to pay attorney fees and other costs incurred by G&S Concrete Cutting in the enforcement of this Guarantee. The obligations herein are independent of the obligations of applicant. I (we) authorize G&S Concrete Cutting to make credit inquiries to banks or credit checking agencies.

Date:

Name of the applicant:

Social security no.:

Guarantor Name:

For Internal Use Only:

Sales Executive Name:

Credit Manager Approval:

Deposit Amount Required:

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	Customer Feedback		535 C, Southlawn Lane Rockville, MD 20850 E-Mail: rwhite@gands.us Cell-Phone :240-565-1223 Fax No:202-558-6192