G.C.I.
Gowri Components Inc.
Credit Application		 2301 West 205th Street Suite 108
Torrance, Ca 90501
Phone: (310)787-7000     Fax: (310)787-7080
E-mail: gci@gci7000.com
Web Page: www.gci7000.com





Los Angeles Time & Date:    

Please Note: Required fields are noted by *
Salesperson:

Company Name: *

Website Address:

Billing Address:
Address: *

City: *
State: *

   Zip Code: *
Country:*
Phone:*

   Fax:*
Contact:*
E-mail:*

Shipping Address:
If same as Billing Address then check here
(If different than Billing Address then fill out below)
Address:*

City:*
State:*

   Zip Code: *
Country:*
Phone:*

   Fax: *
Contact:*
E-mail:*

Number of employees:
Number of years in business:
Date established:


NAMES OF PRINCIPALS OF FIRM: (Required fields *)
President:*
Vice President:*
Treasurer:*
Controller:*
Parent Company:*
Corporation       Partnership       Single ownership
select one *
Type of business:*

Credit line desired per month:*
Purchasing agent:*
Do you use purchase orders?*

 Yes       No
Dunn and Bradstreet No.:*
Is merchandise for resale?*


 Yes       No      

If Yes, Resale number:

BANK REFERENCE: (Required fields *)
Checking Information:
Bank Name:*
Phone:*

       Fax: *
Officer to contact:*
Address:*

City:*



  

State: *   Zip: *
Country:*
Branch:*
Account No.:*

Loan Information:
Bank Name:
Phone:


Fax:
  
   

Officer to contact:
Address:

City:



  

State:   Zip:
Country:
Branch:
Account No.:


TRADE CREDIT REFERENCES: (Within the United States Only)
(Please list 3 References~ Required fields *)

Reference #1
Name:*
Address:*

City:*




  

State: *   Zip: *
Country:*
Phone:*

E-mail:*

       Fax:*      



Reference #2
Name:*
Address:*

City:*

   State: *   Zip:*
Country:*
Phone:*


E-mail:*

       Fax: *  



Reference #3
Name:
Address:

City:

   State:   Zip:
Country:
Phone:


E-mail:
       Fax:      


Please Note: If you would like to Fax us your completed
Application Print this screen and Fax it to: (310)787-7080

Home | Line Card | RFQ | We Buy | Credit Application