Credit Application

Welcome to our online Credit Application Form.

Please fill this form completely and accurately. When complete hit the Submit button found at the bottom of the sheet. If a piece of required info was missed, the field will highlight red.

If preferred, we have printable Credit Application Forms.

Credit Application This can be emailed directly to denise@glennygs.com when complete

* indicates required field

Company Data

*Legal Registered Name:

*Estimated Purchase Amount Monthly

DBA

*Billing Street Address

*Billing City, State, Zipcode

*Delivery Street Address

*Delivery City, State, Zip Code

*Federal Tax ID #

*Business Phone#

Landlord or Mortgage Holder:

Business Fax #

*Owner/ Principal Stockholder

Last four of SSN#

*Email Address for Invoicing

*Email Address for Order Confirmation

Business Type:

* Select One

Bank Reference

*Name

*Phone #

*Address

Fax #

*Last Four of Checking Account #

*Last Four of Savings Account #

*Contact Name

*Email

Business Reference

Two Business references are necssary and one cannot be a glass fabircation competitor (i.e. OldCastle, CR Lawrence, TruLite, etc.).

Business Reference #1

*Name

*Phone #

*Address

Fax #

*City, State, Zip Code

*Contact Name

*Email

Business Reference #2

*Name

*Phone #

*Address

Fax #

*City, State, Zip Code

*Contact Name

*Email

Personal Guarantee

The undersigned must be authorized to approve any listed business requests The Glenny Glass Company deems necessary in order to open an account and certifies that the above information is correct. The Glenny Glass Company is authorized to obtain, receive, and report credit Information on personal credit history for the principals of the authorized company. Each guarantor hereby, unconditionally and absolutely, guarantees payment within the terms of-this account for all amounts which may be due to Glenny Glass Company for glass, materials, or late charges invoiced or otherwise billed. THIS AGREEMENT IS GOVERNED BY LAWS OF THE STATE OF OHIO.

*Signature

clear* Date

For the purposes of procuring and establishing credit with the Glenny Glass Company, the undersigned applicant(s), any or either of them, or otherwise, collectively referred to as "CUSTOMER" agrees to be bound by the terms and conditions hereinafter set forth, which are incorporated by reference herein.

TERMS AND CONDITIONS

Terms of payment: Customer hereby agrees to pay invoice(s) within The Glenny Glass Company's terms of 30 days. New accounts may be COD pending credit analysis and payment history.
Should customer fail to pay any invoice when due, Customer will be charged a late payment charge as liquidated damages upon The Glenny Glass Company's demand. The charge will not exceed1%% per month (18% per annum) of the outstanding purchase price.
Customer agrees to pay all costs and attorney fees incurred in collection of all past due invoices and accounts.
Claims must be made upon receipt of goods. No goods shall be returned once the merchandise is deemed unable to be resold.
All prices subject to change without notice.
The Glenny Glass Company shall not be liable for failure to deliver goods or delays in delivery of goods occasioned by causes beyond its control, including and without limitation, strikes lockouts, fires, embargoes, war, or other outbreaks of hostilities, acts of God, inability to obtain shipping space, machinery breakdowns, delays of certain carriers of suppliers and government acts or regulations.
The Glenny Glass Company reserves the right at anytime to revoke any credit extended to Customer because of Customer's failure to pay for goods when due or for other reasons deemed good and sufficient by them.
Appropriate charges as provided for by applicable state laws shall be imposed in the event of Customer's checks being returned to The Glenny Glass Company for non-sufficient funds, or other non-payment issues.
Customer certifies that the information presented by the Customer in this application is true and correct. THE GLENNY GLASS COMPANY IS AUTHORIZED TO CONTACT ALL REFERENCES CONTAINED IN THE APPLICATION WHO ARE AUTHORIZED TO RELEASE ANY INFORMATION TO IT RELATING TO CUSTOMER'S CREDIT HEREIN.

The undersigned has read the Credit Application and agrees to update this application if information disclosed is no longer accurate.

Signature

clearDate

*Title

Is your Business Tax Exempt?

BLANKET CERTIFICATE OF EXEPMTION (Sales Tax),NO.43___

Blanket Certificate of Exemption

The Undersigned hereby certifies that the articles of tangible personal property purchased
from the

Company Name

after

clearDate

shall be purchased:

(Purchaser must state statutory reason for claiming exemption or exception.)

This certificate shall continue in force until revoked and shall be considered a part of each order given to the above name vendor unless the order specifies otherwise.

Signature

Title

Address

clearDate

Vendor's License, if any