Business Credit Application

Complete this form to apply for a Gator HDD Supply business credit account. Our team will review it and follow up with you.

Authorized Employee Information

PrefixFirst name *Last name *Title / PositionPhone number *Email address *Street addressStreet address line 2CityState / ProvincePostal / ZIP code

Bank Reference 1

Institution nameChecking account #Contact first nameContact last nameContact phoneStreet addressStreet address line 2CityState / ProvincePostal / ZIP code

Bank Reference 2

Institution nameChecking account #Contact first nameContact last nameContact phoneStreet addressStreet address line 2CityState / ProvincePostal / ZIP code

Trade Reference 1

Company nameContact first nameContact last namePhone numberAccount opened sinceCredit limitCurrent balanceStreet addressStreet address line 2CityState / ProvincePostal / ZIP code

Trade Reference 2

Company nameContact first nameContact last namePhone numberAccount opened sinceCredit limitCurrent balanceStreet addressStreet address line 2CityState / ProvincePostal / ZIP code

Trade Reference 3

Company nameContact first nameContact last namePhone numberAccount opened sinceCredit limitCurrent balanceStreet addressStreet address line 2CityState / ProvincePostal / ZIP code

Financial Information

Company total assetsAnnual net incomeAmount of credit requested *

Have you or your officers or affiliates ever filed a petition in bankruptcy? *

Yes No

Is your company subject to any litigation? *

Yes No

Authorization

Company name (as signed) *PrefixFirst name *Last name *Employee title * I certify the information above is true and complete, and I am authorized to apply for credit on behalf of this company. I authorize Gator HDD Supply to verify the bank and trade references and to obtain credit reports.Signature (type your full name) *

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Business Credit Application

Authorized Employee Information

Company Information

Bank Reference 1

Bank Reference 2

Trade Reference 1

Trade Reference 2

Trade Reference 3

Financial Information

Authorization