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Credit Line Requested:
Company Name:
DUNS #:
FEIN:
Business Address:
PO Box:
City:
State:
Zip Code:
Phone Number:
Fax:
Headquarters Address (if different than above):
Type of Business:	Partnership Sole Proprietorship Limited-Liability
Officers & Titles:
Year Established:
Annual Earnings:
Annual Sales:
Is Real Estate/Property:	Owned Leased?
Landlord Name:
Contact:
Landlord Address:
Landlord Phone #:
Landlord Fax:
Bank/Finance Information
Bank Name:
Bank Address:
Account #:
Contact Name:
Phone #:
Fax:
Trade References: (minimum of 3 - attach additional sheet if necessary) Please Provide: Name of Company, Address, Tele. & Fax No., POC for all credit references.
1:
2:
3:
The signature of an Officer of the company is required for credit to be considered. I certify that I am an authorized representative of the Applicant Company. On behalf of the company, I authorize GCS or its representatives to access and review the information and references identified in this Application, and all other relevant information and material, for the purpose of identifying the financial status and credit worthiness of the Applicant Company.