Business Customer Credit Application

* denotes required field.

Thank you for your interest in financing through Graybar Financial Services (GFS). Please note that you are submitting credit information that, if approved, can only be used to lease or finance equipment through GFS. Important! Your GFS line of credit cannot be used for everyday purchases from Graybar.

Please fill out the form below. When you are finished click on the "Submit" button. You should receive a response within one business day. If you would prefer, you may print out the application and fax it to us at 800-543-0274.

If you have any questions, don't hesitate to call us at 800-241-7408.

Contact Info

Vendor Name *

Vendor Email *

Company Info

Company Contact *

Company Name *

Tax Id. No.

Address

City

State

Zip Code

Company Phone Number *

Business Start Date

Number of Employees

Business Type

Duns No.

Equipment Address

Equipment Street Address

State

Equipment County

Equipment Zip Code

Equipment Information

Description of Equipment 1

Description of Equipment 2

Principal Information - Required if NOT a corporation

Principal Officer

Social Sec. No.

Principal Address

Principal City

Principal State

Zip Code

Pricing Information

Equipment Cost

Software Labor

Total Cash Price

Lease Term

Pricing Option

Fair Market Value Fixed Price $1.00 Fixed Price of 10%

Reference Information

Bank Reference 1

Account/Loan Officer

Bank 1 Phone Number

Bank 1 Account Number

Acknowledgements and Authorizations

By clicking on the "Submit" button above, you, the credit applicant, certify, acknowledge and authorize to us the following:

That all information you are providing to us is true and accurate.
That you are applying for credit for a business purpose, and not for personal, family, or household purposes.
That Graybar Financial Services and its affiliates have your authority to request and receive information concerning personal or business credit standing, which may include obtaining personal credit bureau reports from a credit reporting agency.

ECOA Notice

If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please contact: Credit Disclosure Administrator, Graybar Financial Services, 11885 Lackland Road, St. Louis, MO 63146, 800-241-7408 within 60 days from the date you are notified of the credit decision. We will send you a written statement of reasons for the denial of credit within 30 days of receiving your request for the statement.

Notice: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning the credit is the Federal Trade Commission, Equal Credit Opportunity, Washington, DC 20580.

This page contains a notice required under the Equal Credit Opportunity Act. The Lessee is entitled to receive and retain a copy of this notice. When an application for business credit is made solely by telephone, compliance with the notice requirements may be satisfied by oral disclosure of the applicant's right to a statement of the reasons for a denial of credit.