Credit Application

General Information:
Company Name:
CONTACTS:
Address:
President/Owner:
City, State, Zip:
Accounts Payable:
Phone Number:
Phone Number:
Fax Number
Email:
Web Site:
Purchasing:
Fed Tax ID #
Phone Number:
Years in Business:
Email:
Bank References:
Bank Name
Account Number:
Contact Name:
Phone Number:
Address:
Fax Number:
City, State, Zip
Email:
Trade References:
Company Name:
Company Name:
Contact Name:
Contact Name:
Address:
Address:
City, State, Zip:
City, State, Zip:
Phone Number:
Phone Number:
Fax Number
Fax Number
Email:
Email:
Company Name:
Company Name:
Contact Name
Contact Name
Address:
Address:
City, State, Zip:
City, State, Zip:
Phone Number:
Phone Number:
Fax Number:
Fax Number:
Email:
Email:
Please Release Confidential Bank Information to Gtek Automation for the Purpose of Establishing an Open Credit Account. All Information Provided will be Held Completely Confidential.
SIGNATURE OF OWNER OR CORPORATE OFFICER
DATE
NAME (PRINT)
TITLE
CAPTCHA

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General Information: