Please enter your information in the form below to submit an email Credit Application to Genalco. If you prefer, click here for a printable version which you can fax to 781-449-6643.

APPLICATION FOR CREDIT

Name of Business: Esablished:
Address:   Taxable: YES NO
City/State/Zip:  State Exempt#
Phone #
Fax # If you are Tax Exempt please forward a copy of your Tax Exempt Certificate to our office.
Owner/Officer:
REFERENCES: 
Name: Phone #
Address: Contact:
City/State/Zip: Fax #
Name: Phone #
Address: Contact:
City/State/Zip: Fax#:
Name: Phone #
Address: Contact:
City/State/Zip: Fax#:

TERMS OF SALE: NET 30 DAYS. GENALCO RESERVES THE RIGHT TO HOLD SHIPMENTS AGAINST PAST DUE ACCOUNTS.

WE CERTIFY THAT ALL THE ABOVE INFORMATION IS CORRECT AND AGREE TO THE ABOVE TERMS OF SALE.
Authorized Signature:
Title: Date:




 
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