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APPLICATION FOR CREDIT

15041 Calvert St.

VAN NUYS CALIF. 91411

PHONE (818) 785-4151

FAX (818) 785-3719

FOR GENIE USE ONLY:

CREDIT APPROVED

ACCT# ______________

CREDIT LIMIT $ ________

CREDIT REFUSED

*Please print this form and then fill it out, then fax it to us! We must have a signature*

BUSINESS NAME   _________________________________________________________________________________________

STREET ADDRESS _________________________________________________________________________________________

P.O. BOX ______   P.O. BOX ZIP ______    EMAIL _____________ WEBSITE ADDRESS______________

CITY __________  STATE ____    ZIP _______   PHONE# ________________ FAX# ___________

TYPE OF BUSINESS _____________________________     DATE ESTABLISHED ________________

OWNERSHIP - CHECK ONE BELOW

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

NAME _______________________                 TITLE ________________________________

NAME _______________________                 TITLE ________________________________

STATE INCORPORATED IN______________         CORPORATION#____________________________

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

OWNERS NAME  __________________________     SSN  _____________________________

STREET ADDRESS _________________________    CONTRACTOR LICENCE#_________________

CITY __________  STATE ____    ZIP _______   PHONE# ________________ FAX# ___________

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

OWNERS NAME  __________________________     SSN  _____________________________

STREET ADDRESS ____________________________________________________________

CITY __________  STATE ____    ZIP _______   PHONE# ________________ FAX# ___________

OWNERS NAME  ____________________     SSN  _____________________________

STREET ADDRESS ____________________________________________________________

CITY __________  STATE ____    ZIP _______   PHONE# ________________ FAX# ___________

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    NAME  _______________________     ACCT#  ____________________________

CHECKING      BRANCH   ________________________

LOAN       STREET ADDRESS  _____________________________

CITY __________  STATE ____    ZIP _______   PHONE# ________________ FAX# ___________

SAVINGS    NAME  _______________________     ACCT#  ____________________________

CHECKING      BRANCH   ________________________

LOAN       STREET ADDRESS  _____________________________

CITY __________  STATE ____    ZIP _______   PHONE# ________________ FAX# ____________

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.

1. NAME  __________________________________

STREET ADDRESS  __________________________________

CITY __________  STATE ____    ZIP _______   PHONE# ________________ FAX# ___________

2. NAME  __________________________________

STREET ADDRESS  __________________________________

CITY __________  STATE ____    ZIP _______   PHONE# ________________ FAX# ___________

3. NAME  __________________________________

STREET ADDRESS  __________________________________

CITY __________  STATE ____    ZIP _______   PHONE# ________________ FAX# ___________

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
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 PAST DUE 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 ______    EMAIL ___________________ URL________________

CITY __________  STATE ____    ZIP _______   PHONE# ________________ FAX# ___________

DATE _______________

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______________________________