Credit application

Printable PDF Version here

Please complete the form below. Mandatory fields marked *

General Information

Name *	Phone *
Address *	Fax
City *	Postal Code *
Credit limit	Contact
Responsible

Financial Institution

Name	Phone
Address	Fax
City	Postal Code
Contact

Suppliers (very important to provide us with 3 of your principal suppliers)

Name	Phone
Address	Fax
City	Postal Code
Contact

Name	Phone
Address	Fax
City	Postal Code
Contact

Name	Phone
Address	Fax
City	Postal Code
Contact

GPM Ripe inc. is hereby authorized to obtain information it considers necessary to process this credit application. The undersigned has authorized its bank to respond to our credit inquiries. By signing this request, I/we consent to pay the purchase price of goods and services within a period of thirty (30) days from the invoice date. The undersigned agrees to pay interest on overdue accounts at 24% per year or 2% per month.

Note: All above-mentioned information will serve to the credit department and will be kept in all confidentiality.