Account Information

Account Name *

Business/Billing Address *

City *

State/Province *

Zip/Postal Code *

Primary Shipping Address *

City *

State/Province *

Zip/Postal Code *

Type of Ownership *

Example: LLC Sole Member

Social Security # (Sole Proprietor) *

Years in Business *

Example: Established 12/2020

Credit Line Requested *

Buying Group *

GSP Sales Rep *

Submit a copy of current Tax Certificate *

Choose file or drag here

Supported format: JPG, JPEG, PNG, GIF, SVG.

temp-for-143707-file2-1_

Bank References

Bank Name *

Account Number *

Branch *

Contact *

Phone Number *

Address *

City, State *

Zip/Postal *

Name of Bank, Mortgage Company or Savings and Loan *

Contact Information

President/Owner

Name

Phone

Finance/AP

Name

Phone

Purchasing

Name

Phone

Pricing

Name

Phone

Marketing

Name

Phone

Sales Manager

Name

Phone

Trade References

Please indicate at least three (3) references. (If the customer has a prepared list of Trade References that includes all of the required information it may attached in lieu of completing this section.)

Company Name *

Account Number *

Address *

City/State *

Zip/Postal *

Phone Number *

Fax Number

Remarks *

Company Name

Account Number

Address

City/State

Zip/Postal

Phone Number

Fax Number

Remarks

Company Name

Account Number

Address

City/State

Zip/Postal

Phone Number

Fax Number

Remarks

Delivery/Shipment Information

Contact Name *

Phone Number *

Email *

EDI Capability *

Yes No

If Yes, Service Provider *

Other PO Submission Capability *

Preferred Method of Payment *

ACH/Check/Credit Card

Ship To *

Contact *

Address *

City, State *

Zip/Postal *

Phone Number *

Fax Number

Ship To

Contact

Address

City, State

Zip/Postal

Phone Number

Fax Number

Ship To

Contact

Address

City, State

Zip/Postal

Phone Number

Fax Number

Ship To

Contact

Address

City, State

Zip/Postal

Phone Number

Fax Number

Please attached a separate sheet for any additional SHIP TO locations

Choose file or drag here

Supported format: JPG, JPEG, PNG, GIF, SVG.

temp-for-143707-file2-3_

Does the customer require the following to take felivery of their orders? *

Lift Gate
Pallet Jack
N/A

Marketing

Please list all business locations to be included in GSP’s Distributor Locator. (If the customer has a prepared list of all business locations that includes all of the required information it may attached in lieu of completing this section.)

Company Name *

Hours *

Address *

City, State *

Zip/Postal *

Phone Number *

Fax Number

Website URL *

Company Name

Hours

Address

City, State

Zip/Postal

Phone Number

Fax Number

Website URL

Company Name

Hours

Address

City, State

Zip/Postal

Phone Number

Fax Number

Website URL

Company Name

Hours

Address

City, State

Zip/Postal

Phone Number

Website URL

Social Media Information

Social Media Contact

Name

Phone

Facebook

Instagram

Youtube

Other

By signing below I acknowledge and confirm that any and all information provided is acurate.

Customer Name *

Date *

Customer Signature *

Clear

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