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Credit Application
To better serve your needs, please tell us about your business.
 
Part I
 
Name of Business:
Billing Address:
Address:
City: State: Zip Code:
Shipping Address:
(if different from billing)
Address:
City: State: Zip Code:
Primary Telephone: Fax:
Alternate Phone: Email:
Principle Owners:
Date Business Opened: New Ownership: Date of Change:
State Sales Tax # (COPY OF CERTIFICATE IS REQUIRED OR SALES TAX WILL BE CHARGED):
Business Standard as:
Type of Business:
Primary Business Trade:
Business Location:
Product Interest:
 
Part II
How will you be paying for your merchandise?
Please check at least one of the following:
 
Amount of credit line requested $
 
Credit Card Information: for security purposes we are unable to maintain your credit card information on file. After your order is processed, someone from the Credit department will contact you for your credit card information. You should always be asked for the following:
  • Bank Card #
  • Card Holder Name
  • Expiration Date:
  • Card Security Code
  • Zip code where the card is Billed
TERMS AND CONDITIONS
 
Any Payment received from the purchaser may be applied to C.R. GIBSON. The acceptance of such payment shall not constitute a waiver for the right to pursue any remaining balance. The purchaser agrees that any payment tendered for less than the full amount of the billing being paid thereby shall constitute an on account payment, irrespective of a contrary instruction.

The purchaser shall pay all billing not in dispute. The purchaser agrees to pay all cost and expenses, including actual attorney’s fees, expended or incurred as enforcement of this agreement. Any return of product must be authorized and may be subject to a restocking fee of at least 15%.

Checks returned from the bank (N.S.F., Stop Payment, Uncollected Funds) are subject to a $25.00 processing fee. Late payments may be subject to a late payment fee in the amount of 1.5% per month or the higher legal rate with respect to applicable state law.

By clicking the "I agree" button below, I am
(i) signifying the purchaser's acceptance of the foregoing Terms and Conditions and providing the foregoing Credit Investigation Authorization, and
(ii) representing personally that
   (A) the information provided to C.R. Gibson is accurate and complete, and
   (B) I have authority to bind the purchaser to the foregoing Terms and Conditions and to authorize the Credit Investigation referred to above.

I acknowledge and agree that clicking "I agree" has the same legal effect and validity as my written signature. I acknowledge that I have no obligation to click "I agree," but if I fail to do so C.R. Gibson will not extend credit to the purchaser.



 
 
Name of Owner, Manager, or Buyer
 
Name of Owner, Manager, or Buyer
 
 
IF YOU ARE PAYING BY CREDIT CARD YOU NEED ONLY COMPLETES PARTS I AND II.
IF YOU ARE REQUESTING A LINE OF CREDIT & PAYMENT TERMS YOU MUST ALSO COMPLETE PART III.
 
 
Part III
Banking Reference
Name of Bank
Account #
Address,City,State,Zip
Telephone Fax #
REFERENCES:
1. Company:
Address
City State Zip Code
Telephone Account #
Fax E-Mail:

 
2. Company:
Address
City State Zip Code
Telephone Account #
Fax E-Mail:

 
3.Company:
Address
City State Zip Code
Telephone Account #
Fax E-Mail:

 
 
CREDIT INVESTIGATION AUTHORIZATION
In accordance with the Fair Credit Reporting Act, Public Law 91-508, I authorize C.R. Gibson to receive full information as requested relating to our Bank and Credit experiences.
Company Name
Fair Credit Reporting Act, Public Law 91-508 requires customer authorization for credit investigation.
Authorized Name & Title
AUTHORIZATION MAY ONLY BE GIVEN BY AN AUTHORIZED SIGNER ON THE ACCOUNT.
By clicking the "I agree" button below, I am
(i) signifying the purchaser's acceptance of the foregoing Terms and Conditions and providing the foregoing Credit Investigation Authorization, and
(ii) representing personally that
   (A) the information provided to C.R. Gibson is accurate and complete, and
   (B) I have authority to bind the purchaser to the foregoing Terms and Conditions and to authorize the Credit Investigation referred to above.

I acknowledge and agree that clicking "I agree" has the same legal effect and validity as my written signature. I acknowledge that I have no obligation to click "I agree," but if I fail to do so C.R. Gibson will not extend credit to the purchaser.

Date
 
 
   
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Have questions or need help? Call us Toll-free 1-800-243-6004 (US) or 1-615-724-2858 (INTL)
 
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