Outdoor Pest Repellers
Battery Bird Repeller
Solar Bird Repeller
Solar Mole Repeller
Solar Pest Repeller
Solar Raccoon Repeller
Solar Rodent Repeller
Solar Snake Repeller
Solar Squirrel Repeller
Personal Mosquito Repeller
Bug Repeller Light
 
Indoor Pest Repellers
Multifunctional Pest Repeller
Ultrasonic Mosquito Repeller
Ultrasonic Mouse Repeller
Bug Repellent CFL Bulb
 
Animal Control
Solar Animal Repeller
Solar Cat Repeller
Solar Dog Repeller
Solar Deer Repeller
Solar Fox Repeller
Portable Dog Repeller
Bark Control & Trainer
 
Toothbrush Sanitizers
Cup Style Toothbrush Sanitizer
Family Toothbrush Sanitizer
Travel Toothbrush Sanitizer
Pet Toothbrush Sanitizer
 
Air Sanitizers & Air Purifiers
Air Sanitizer, Air Cleaner & Deodorizer CFL Bulbs
Plug-In Ionic Air Purifier & Deodorizer with night light (US)
Plug-In Ionic Air Purifier & Deodorizer with night light (EU)
 
Hand Odor Remover
Chemical Free Hand Deodorizer
 
First Aid Kit
 
Newsletter Signup
 
 
 
We accept all major cards
 
 
Follow us on the web:

Facebook

YouTube

GooglePlus

Pinit
 
Like, Pin & Add Us:
       
Online Credit Application Form

Note: This is an HTML form. You MUST have a browser that supports forms in order to use it.
Please fill the form in carefully. If you have difficulties, send e-mail directly to:
GOVATIONS

Please fill out form completely and carefully.

ADDRESS
Name:
Title:
Company:
Address:
City:
State:
Zip:
Country:
Phone:
FAX:
Email:

_____________________________________________________________________

PRINCIPALS (if corporation, list officers, if partnership, list partners)
1.

Name:
Title:
Home Address:
City:
State:
Zip:
Country:
Phone:

_____________________________________________________________________

2.
Name:
Title:
Home Address:
City:
State:
Zip:
Country:
Phone:

_____________________________________________________________________

3.
Name:
Title:
Home Address:
City:
State:
Zip:
Country:
Phone:

_____________________________________________________________________

SALES TAX STATUS

Not Tax Exempt
Tax Exempt --- Exempt # 

_____________________________________________________________________

BANK REFERENCE

Bank Officer:
Bank Name:
Address:
City:
State:
Zip:
Country:
Phone:
Account #:

_____________________________________________________________________

TRADE REFERENCES
1.

Contact Name:
Company:
Address:
City:
State:
Zip:
Country:
Phone:

_____________________________________________________________________
2.

Contact Name
Company
Address
City
State
Zip

Country
Phone

_____________________________________________________________________
3.

Contact Name
Company
Address
City
State
Zip

Country
Phone

_____________________________________________________________________

BUSINESS INFORMATION

Individual
Partnership
Corporation

Type of Business
Number of Employees
Years in Business
Annual Sales $
D+B Listed? Yes No
Amount of Credit Requested $

_____________________________________________________________________

BY COMPLETING THIS APPLICATION FOR CREDIT, THE APPLICANT:

1. Attests financial responsibility, ability and willingness to pay all invoices
in accordance with the following terms: 2% 30; Net, 30 days, service charges will be
paid at the rate of 1.5% (18% annual rate) on all balances over 30 days.

2. Hereby Authorizes GOVATION. to investigate
the references listed pertaining to the applicant's credit and financial responsibility and
obtain additional information by securing data from a credit reporting agency.

3. Hereby Agrees that should it become necessary to assign the applicant's
account to a licensed collection agency or atttorney for legal action, all subsequent
collection charges and legal fees shall be paid by the applicant.

4. Hereby Authorizes the seller, its successors and assigns, by the seller's
designated attorney to waive the issuance of process and confess judgment against the
applicant for the entire unpaid balance of applicant's account together with all costs
applicable to such action.

5. Certifies and Warrants that the information given in this application is true and
correct and is given for the purpose of obtaining credit.

Applicant Name:
Position:
Date:
   
Applicant Name:
Position:
Date: