Credit Application

To apply for GUTZ credit, either use the convenient online form below or download a PDF version to print off and mail or fax - gutz-credit-application.pdf

Company Information

Company Legal Name:
Date of Incorporation:
No. of Years in Business:

Mailing Address

Street Number & Name:  City:
Province/State:  Postal/Zip Code:

Shipping Address

Street Number & Name:  City:
Province/State:  Postal/Zip Code:
E-mail Address :
Contact Person:
Phone No.:
Fax No.:

Trade References

Name:  Phone No.:  Fax No.:
Name:  Phone No.:  Fax No.:
Name:  Phone No.:  Fax No.:

Bank Information

Street Number & Name:  City:
Province/State:  Postal/Zip Code:
Account Number :
Account Name:
Contact Person:
Phone No.:
Fax No.:

Terms of Credit

All accounts are NET 30 DAYS. Interest @ 2% per month will be charged on all invoices older than 30 days. I hereby agree to pay any interest charged appearing on my statement. I also agree to allow GUTZ Emergency Medical Supply to check our credit rating with the above references.