Credit Application

Company Name (required)

Billing Address

Shipping Address

Phone Number

Fax Number

Your Name

Your Phone Number

Your Email (required)

Number of Years in Business

Requested Credit Level with GDS

Business Tax ID

Principals:

Name

Address

Contact

Phone Number

______________________________________________

Name

Address

Contact

Phone Number

Bank References:

Name

Address

Contact

Phone Number

Account Number

______________________________________________

Name

Address

Contact

Phone Number

Account Number

Name

Phone Number

Fax Number

______________________________________________

Name

Phone Number

Fax Number

______________________________________________

Name

Phone Number

Fax Number

Is your business tax exempt?
YesNo

If yes, please upload resale certificate.

Information Provided by:

Your Name (required)

Title

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