Credit Application

Please complete the Credit Application if you are applying for a GHC Products, Inc. Account

 

Legal Name (required)

Contact Name (required)

Contact email (required)

Physical Address (required)

Mailing Address (if different)

Telephone (required)

Fax Number

Business Type (required)

Description of Business (required)

Resale Number

Resale License Copy

Bank References

Bank Name (required)

Bank Address (required)

Bank Contact Name (required)

Bank Contact Telephone Number (required)

Trade References

Supplier 1

Supplier (required)

Supplier Address (required)

Supplier Telephone (required)

Supplier Fax Number (required)

Supplier Contact Name (required)

Supplier Credit Limit (required)

Supplier 2

Supplier 2 (required)

Supplier 2 Address (required)

Supplier 2 Telephone (required)

Supplier 2 Fax Number (required)

Supplier 2 Contact Name (required)

Supplier 2 Credit Limit (required)

Supplier 3

Supplier 3 (required)

Supplier 3 Address (required)

Supplier 3 Telephone (required)

Supplier 3 Fax Number (required)

Supplier 3 Contact Name (required)

Supplier 3 Credit Limit (required)

[recaptcha]