Application for Credit

Physical Address
Billing Address
Type of Business

Contact Information




Are Purchase Orders Required?

List below the following information: Corporate Officers, Individual Owners or Partners

Value of Applicant's Business - Financial Statement Period Ending

Sales Tax Exemption?
*If claiming exempt, please attach the appropriate and active exemption certificate

Trade References

Bank References

The undersignedauthorizes all banksor financialinstitutions of any kind to providefullfinancial and credit history and any requested account information of the Applicant to Genset Services.

Describe Legal Relationship between Applicant and Parent Company, if any

Which Party is Ultimately Responsible for Payment of Charges?

By signing below, the undersigned, referred to as Applicant, hereby acknowledges that they have read and understand the Credit Terms and Conditions contained herein. The Applicant further agrees that such Credit Terms and Conditions shall govern and control this Application, the extension of credit by Genset Services, Inc., or any of its affiliates or subsidiaries (collectively "Genset"), and the relationship between Genset Services, Inc. and the Applicant. The failure by Genset to insist upon the performance of any of the terms or conditions contained herein or to exercise any rights hereunder shall not be deemed to be a waiver of such terms, conditions or rights in the future, nor shall it be deemed to be a waiver of any other term, condition or right. While the Applicant and Genset may enter into additional or other agreements between them, the Credit Terms and Conditions shall, at all times, supersede any control provisions in any other contract or agreement between the parties. A facsimile of this application shall be enforceable as an original.

The Equal Credit Opportunity Act ("ECOA") prohibits credit grantors from discriminating against credit applications on the basis of race, color, religion, national origin, sex, marital status or age (provided the Applicant has the capacity to contract). The ECOA also states that creditors must approve or reject a credit application within 30 days, assuming it is a fully completed application, and must provide an explanation for denying credit within 60 days, if requested. The Federal Trade Commission administers compliance with the ECOA.


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Your account will be subject to the following Credit Terms and Conditions. Applicant agrees with Genset to pay for all purchases in accordance with Genset's terms. Delinquent accounts are subject to a $50.00 late fee per occurrence as well as additional finance charges. The finance charge shall be computed by applying the periodic rate of 1.50% per month to any outstanding and unpaid balance, which equates to an annual percentage rate of 18.0%. Applicant assumes full responsibility for payment of all materials and services purchased from Genset. Applicant agrees to notify Genset in writing within ten (10) days of receipt of any invoice of any discrepancy in billing. Failure to notify Genset within that timeframe signifies to all parties Applicant's complete acceptance and responsibility for prompt payment to Genset of its account in full. Any modification and/or alteration by purchase order, purchase agreement, or other written contract shall not be valid unless it is in writing and signed by an officer of Genset. This provision takes precedence over all subsequent actions: written, oral, direct, or implied. If materials ordered are to be delivered by Genset to a particular job site or location, Applicant assumes liability for the materials at the time of delivery, whether or not Applicant's representative is on hand to acknowledge receipt of delivery. Applicant agrees to pay standard delivery charges as billed. Applicant agrees to pay Genset $50.00 for each instance of NSF, bounced checks, credit card chargebacks, or ACH chargebacks. If Applicant's credit or payment history becomes unsatisfactory to Genset, Genset reserves the right, in its sole discretion, to terminate the Applicant's availability of credit upon notice to Applicant and without liability to Genset.

Genset reserves the right to send out "Notice to Owners" and file liens on past due accounts and use any legal means available to force collection, if such action becomes necessary. Should any portion of the Applicant's account be referred to an attorney for collection, Applicant shall be required to pay all of Genset's expenses of collection, including reasonable attorney's fees, whether or not suit is filed. Applicant consents to venue for any and all legal action in Broward County, Florida, as selected by Genset. By utilizing the extension of credit made available to it by Genset in its sole discretion, Applicant signifies the full acceptance of these terms and conditions. With respect to materials purchased from Genset, Genset hereby disclaims all warranties, express or implied, including but not limited to any implied warranties of merchantability and fitness for a particular purpose and shall not be liable for any loss or damage, directly or indirectly, arising from the use of such products or for any consequential or incidental damage. The Applicant's representative, indicated above by his/her signature, has the full authority to bind the Applicant to the terms of this credit application.

Genset's cancellation policy shall apply to all purchases made under these Credit Terms and Conditions, a copy of which shall be provided to Applicant upon request. Monetary credit will be allowed for unused goods returned by Applicant to Genset only with Genset's prior approval. Genset will charge the Applicant a $25.00 restocking fee associated with each instance of the return of non-defective items. Special order items cannot be returned

Customer Authorization for Release of Information

, or my designee recently completed an application for credit with Genset Services, Inc. In connection with that application,

our company has been requested to provide information concerning certain of its financial capabilities and history. I therefore authorize such disclosure to Genset Services, Inc. Your release of credit information on our behalf is authorized whether such information is of record or not. Furthermore, I release you and all persons, agencies, agents, employees, firms, companies, or parties affiliated with you from any damages resulting from providing such information.

Time is of the essence. This authorization is valid for thirty (30) days from the date of my signature below. Please keep a copy of my release request for your files. Thank you in advance for your cooperation.

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