Dealer Application - Welcome, GPA is your partner in selling prepaid.
ACCOUNT (DEALER) INFORMATION
Dealer Name:
Type of Business:
Years in Business:
(Contact Name)First:
Last:
Email Address:
Primary Phone:
Alternate Phone:
Fax Number:
(Mailing Address)Street Address:
City:
State:
Zip:
Company DBA (if applicable):
Company Web Address (if applicable):
PERSONAL GUARANTY
In order to induce GPA to enter into this Agreement, I/we, the Guarantor(s), do hereby unconditionally guarantee
the due and punctual payment, performance, and discharge when and as the same shall become due of all obligations of
the Dealer to GPA under this Agreement, together with interest thereon at the rate set forth in this Agreement and
all expenses incurred by GPA in connection with the collection from Dealer or me, of the obligations created by this
Agreement, including, without limitation, reasonable attorney's fees, expenses and costs. The Guaranty is a primary and
original obligation and is an absolute, unconditional, and continuing guaranty of payment and performance and shall remain
in full force and effect until revoked in writing by me, but such revocation shall not affect my obligation with
respect to any of the obligations existing at the time of receipt by GPA of my revocation If there is more
than one Guarantor, each such Guarantor shall be jointly and severally liable. GPA may proceed against any Guarantor
with or without joining or first proceeding against the Dealer entity or any other persons or Guarantors. I, the
undersigned guarantor, hereby authorize GPA to investigate my personal credit standing, financial circumstances, and responsibility,
and specifically authorize GPA to obtain consumer reports and all other relevant reports for making such investigation.
This authorization relates to the purchase and processing of prepaid products and services. I understand that without
this authorization GPA may not be entitled to obtain this information.
Date:
Date:
PAYMENT METHOD
AUTHORIZATION FOR EFT ACH PAYMENTS
DEALER hereby authorizes GPA, Inc. ("GPA") to initiate debit entries to its:
Business Account
Personal Account (please check one)
Checking Account
Savings Account (please check one)
The account number of which is indicated below at the depository financial institution named below (the "Depository"), and
to debit amounts to such account. GPA acknowledges that the origination of ACH transaction to its account must comply with the provisions of U.S. law.
Depository Name (Bank):
Branch:
Bank Branch Phone Number:
(Bank Mailing Address)Street Address:
City:
State:
Zip:
Routing Number:
Account Number:
This authorization is to remain in effect until GPA has received written notification from the Company of its termination in such time
and in such manner as to afford GPA and the Depository a reasonable opportunity to act on it (a minimum of 14 days).
Date:
