Commercial Credit Request

Date

Month

Day

Year

Legal company name as appears on W-9

Company address

Company EIN

First name

Last name

Position

Yes, I am a legal representative of the company and authorized to sign on its behalf.

Phone

Years in business

Trade References

1. Trade name

Address

Phone

2. Trade name

Address

Phone

3. Trade name

Address

Phone

By signing I agree the information provided is true and any false representations made herein could result in termination of credit request. I also agree, if credit is extended, the company will abide by the terms granted to me upon credit approval.

Signature

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Personal Guaranty

By signing, I agree to personally guaranty any and all charges made on behalf of the company represented herein. I understand I will be held personally responsible for and agree to pay for any and all unpaid invoices according to the terms given to me upon credit approval. I also agree by submitting my personal social security number, I authorize HVAC EMT to obtain my credit report for the purposes of extending credit on my behalf based on the credit information received in my credit report.

Social Security Number --- -- ----

Signature

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Form W-9 (Rev. March 2024)

Commercial Credit Request

Trade References

Fill out the above W-9 Form, sign and return.