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APPLICATION FOR CREDIT

15041 CALVERT ST.
VAN NUYS, CA 91411
PHONE (818) 785-4151
FAX (818) 785-3719

FOR GENIE USE ONLY:

CREDIT APPROVED

ACCT# _______________________

CREDIT LIMIT $ ______________

CREDIT REFUSED


*Please fill all fields, then print, sign and fax/email it to us! We must have a physical signature*

BUSINESS NAME     

STREET ADDRESS   

P.O. BOX   

P.O. BOX ZIP  



CITY    STATE    ZIP   


PHONE #   

FAX #   


EMAIL   

WEBSITE   




TYPE OF BUSINESS   

DATE ESTABLISHED (MM/DD/YYYY)     /   / 


OWNERSHIP (CHECK ONE BELOW)

THIS BUSINESS IS A CORPORATION (IF CHECKED, GIVE NAMES OF CORPORATE OFFICERS)

NAME   

TITLE   



NAME   

TITLE   



FED ID #   STATE INCORPORATED IN   CORPORATION #  


THIS BUSINESS IS A SOLE PROPRIETORSHIP (IF CHECKED, FILL OUT THE INFORMATION BELOW)

OWNERS NAME   

SSN # (*** - ** - ***)     /   / 


PHONE #    FAX #    CONTRACTOR LICENCE #   


STREET ADDRESS    CITY    STATE    ZIP   




THIS BUSINESS IS A PARTNERSHIP (IF CHECKED, FILL OUT THE INFORMATION BELOW)

OWNERS NAME   

SSN # (*** - ** - ***)     /   / 


PHONE #    FAX #    CONTRACTOR LICENCE #   


STREET ADDRESS    CITY    STATE    ZIP   



OWNERS NAME   

SSN # (*** - ** - ***)     /   / 


PHONE #    FAX #    CONTRACTOR LICENCE #   


STREET ADDRESS    CITY    STATE    ZIP   




IF BILLS ARE PAID BY A PARENT COMPANY, FILL IN THE INFORMATION BELOW

PARENT COMPANY     

STREET ADDRESS    CITY    STATE    ZIP   


PHONE #   

FAX #   


BANK REFERENCES

SAVINGS CHECKING LOAN

NAME   

ACCT#   

BRANCH    PHONE #    FAX #   

STREET ADDRESS    CITY    STATE    ZIP   



SAVINGS CHECKING LOAN

NAME   

ACCT#   

BRANCH    PHONE #    FAX #   

STREET ADDRESS    CITY    STATE    ZIP   





COMMERCIAL TRADE REFERENCES
(GIVE ONLY NAMES OF THOSE YOU BUY FROM ON OPEN ACCOUNT)

*REFERENCES WILL NOT BE CONSIDERED VALID UNLESS FULL NAMES AND ADDRESSES ARE INCLUDED.
**PLEASE LIST A MINIMUM OF THREE (3) REFERENCES.

REFERENCE #1

NAME   

STREET ADDRESS   

CITY    STATE    ZIP   


PHONE #   

FAX #   

REFERENCE #2

NAME   

STREET ADDRESS   

CITY    STATE    ZIP   


PHONE #   

FAX #   

REFERENCE #3

NAME   

STREET ADDRESS   

CITY    STATE    ZIP   


PHONE #   

FAX #   

REFERENCE #4

NAME   

STREET ADDRESS   

CITY    STATE    ZIP   


PHONE #   

FAX #   

I authorize Genie Air Conditioning Inc. to obtain information about my accounts from the above listed banks and creditors.

NAME   

SIGNATURE   


REQUIRED AUTHORIZATION SIGNATURE BELOW

AMOUNT OF CREDIT DESIRED MONTHLY    $    .  

RESALE PERMIT #   

CLICK HERE TO FILL OUT RESALE FORM

PURCHASE ORDER REQUIRED? YES NO

ACCOUNTS PAYABLE CONTACT:

NAME    EMAIL    PHONE   

BILLING INSTRUCTIONS   

SHOULD GENIE AIR APPROVE THIS APPLICATION, I / WE AGREE TO PAY FOR GOODS PURCHASED WITHIN 30 (THIRTY) DAYS OF INVOICE DATE. GENIE AIR IS AUTHORIZED TO RUN A CREDIT REPORT AND TO CONTACT ANY REFERENCES OR BANKS LISTED ABOVE. IT IS UNDERSTOOD THAT ANY INFORMATION OBTAINED WILL BE USED SOLELY FOR GRANTING CREDIT. SERVICE CHARGES AT THE HIGHEST RATE PERMITTED BY STATE LAW WILL BE APPLIED TO PASTDUE ACCOUNTS. SHOULD IT BECOME NECESSARY TO COLLECT THIS ACCOUNT THROUGH AN ATTORNEY, LEGAL PROCEEDINGS, OR OTHERWISE, THE UNDERSIGNED, INCLUDING ENDORSERS, PROMISE TO PAY ALL COSTS OF COLLECTION, INCLUDING REASONABLE ATTORNEYS FEES. IF THERE IS A LAWSUIT, CREDITOR AGREES TO SUBMIT TO THE JURISDICTION OF LOS ANGELES COUNTY, CITY OF VAN NUYS, STATE OF CALIFORNIA.

BUSINESS NAME     

STREET ADDRESS   

P.O. BOX   

P.O. BOX ZIP  



CITY    STATE    ZIP   


PHONE #   

FAX #   


EMAIL   

WEBSITE   



DATE (MM/DD/YYYY)     /   / 


TITLE   

SIGNATURE   


AUTHORIZED BUYER/ CO. OFFICER/ PARTNER


Individual Personal Guarantee


I, ________________________________ , RESIDING AT ___________________________________ FOR AND IN
CONSIDERATION OF YOUR EXTENDING CREDIT TO _____________________________ (Name Of Company) (HEREIN AFTER REFERRED TO AS THE "COMPANY") OF WHICH I AM _________________________ (Title) HEREBY PERSONALLY GUARANTEE PAYMENT TO GENIE AIR CONDITIONING & HEATING INC. IN THE STATE OF CALIFORNIA FOR ANY OBLIGATION OF THE COMPANY. I HEREBY TO BIND MYSELF TO PAY GENIE AIR CONDITIONING ON DEMAND ANY SUM WHICH AGREE MAY BE DUE BY THE COMPANY WHENEVER THE COMPANY SHALL FAIL TO PAY THE SAME. IT IS UNDERSTOOD THAT THIS GUARANTY SHALL BE A CONTINUING AND IRREVOCABLE GUARANTY AND INDEMNITY FOR SUCH INDEBTEDNESS OF THE COMPANY. I HEREBY WAIVE NOTICE OF DEFAULT, NON-PAYMENT AND NOTICE THEREOF, AND CONSENT TO ANY MODIFICATION OR RENEWAL OF THE CREDIT AGREEMENT HEREIN GUARANTEED.



Witness ______________________________ Guarantor _________________________

Signature ____________________________ Signature _________________________

Address______________________________