Credit Application | Galvan Electrical

CREDIT APPLICATION FOR NEW CUSTOMERS

Document Uploads (Optional, Not Required!)

examples: W-9, resale certificate, tax exempt documentation, references

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 10 MB, Max. files: 3.

CUSTOMER BILLING INFORMATION

Company Name*

Phone:*

Fax:

E-mail:*

Physical Address:*

Street Address City State / Province / Region ZIP / Postal Code Country

Number of Years in Business:*

Sole proprietorship:*

Partnership:*

Corporation:*

Other:*

Tax Exemption:*

BUSINESS AND CREDIT INFORMATION

Billing Address City State / Province / Region ZIP / Postal Code Country

Years at current address

A/P Telephone:

A/P Fax:

A/P E-mail:

Type of Industry:

Annual Sales (USD)

Are you a member of a buying group?

I-Mark or Affiliated Distributors (for electrical distributors)

Bank name:

Bank Address City State / Province / Region ZIP / Postal Code Country

Phone:

Bank Contact:

BUSINESS/TRADE REFERENCES

Company name:*

Address City State / Province / Region ZIP / Postal Code Country

Phone:

Fax:

E-mail:

Type of account:

Company name:*

Address City State / Province / Region ZIP / Postal Code Country

Phone:

Fax:

E-mail:

Type of account:

Company name:*

Address City State / Province / Region ZIP / Postal Code Country

Phone:

Fax:

E-mail:

Type of account:

AGREEMENT

All invoices are to be paid 30 days from the date of the invoice. A finance charge of 1.5% will be charged for balances 30 days past due.
By submitting this application, you authorize Galvan Industries, Inc. to make inquiries into the banking and business/trade references that you have supplied, as well as periodic credit checks
Faxed application is deemed to be original. No oral agreements or modifications will be accepted.
Galvan Industries reserves the right to revoke credit, demand payment in full, and/or reduce the credit line amount. If reasonable collection or legal action is deemed necessary by Galvan Industries to receive monies owed, the collection or legal fees shall also be charged to, and paid by the above person, business, or organization.
Signature below is an acceptance of terms and conditions set forth in this agreement and certification that information on this form is correct.

SIGNATURE X*

Title:

Printed Name:*

First Last

Date:

Office Use Only

Approved/Disapproved:

Customer Group:

Account No:

Credit

CREDIT APPLICATION FOR NEW CUSTOMERS

CUSTOMER BILLING INFORMATION

BUSINESS AND CREDIT INFORMATION

BUSINESS/TRADE REFERENCES

AGREEMENT

Office Use Only

GUARANTEE

Distributors: Stock up now and put turkey on the table with Galvan’s Annual Butterball Promotion

New Pre-Knurled Ground Rods from Galvan Save Time and Money

Galvan Electrical Catalog Features Latest Product Info Plus NEC, NESC and RUS Specs

Distributors: Stock up now and put turkey on the table with Galvan’s Annual Butterball Promotion

New Pre-Knurled Ground Rods from Galvan Save Time and Money

Galvan Electrical Catalog Features Latest Product Info Plus NEC, NESC and RUS Specs