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					                                                     Confidential Credit Application

Company:                                                                                               Phone:
Billing Address:
Shipping Address:
                                                                                                                  Zip
City:                                                            County:         State:                         Code:
Parent Company:
Address:

    Corporation                  Partnership                           Single Ownership
Names of Principals of Firm
                                                                                                 Chief
                                                                                                 Financial
President:                                                                                       Officer:
                                                                        Purchasing Agent or
Do you use purchase orders?                Yes        No                authorized person

                   Tax: All sales orders are considered taxable unless a signed certificate of exemption is provided.

                                                 Number of                                         D&B
How long in business?                            employees:                                        Number:
Type of business:                                                                Main product:
    Bank - Checking:
              Name                                                               Account Number
Address:
Phone                                            Contact
    Bank       - Loan:
                 Name                                                            Account Number
Address:
Phone                                            Contact

Assets pledged?               Yes         No        With whom?
Trade Credit References

1       Name                                                                                  Phone & Fax
        Address

2       Name                                                                                  Phone & Fax
        Address

3       Name                                                                                  Phone & Fax
        Address


Financial statement may be required to open the account.
    Attached             Refused             Will furnish upon written request

Accounts not paid within 30 days shall be subject to an interest charge. In the event of litigation reasonable attorney fees, as
determined by the Court, shall be awarded to Geeco Sales Company in the state of Texas.

Signature of customer                                                                                   Title

Email address _________________________________________

Please complete this form and fax it to GEECO Sales Company at (979) 266-7468 or mail to 903 Brockman Rd. Clute, TX 77531

				
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posted:9/23/2011
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