Credit Reference




    Contact Information



    Company Referenced


    CID Reference #


    Company Name


    Your Name (First Last)


    E-Mail Address


    Phone




    Credit Information



    Approximate Business Duration


    Current Balance


    Amount Due 30-60 Days


    Amount Due 60+ Days


    Current Terms


    Average Days to Pay


    Please rate their credit history


    Date of Last Sale


    Additional Information or Relevant History

    By sending this form you understand and accept that all information gathered and obtained through this form submission is used for evaluating and establishing business credit with G&T Industries with the applicant listed as "Company Referenced". All feedback is confidential and no information is shared with any third parties outside of your Business Institution.