The Contour Projector
Strip Lighting

Credit Application

 

  Date
Legal Company Name
Billing Address
Physical Address (if different)
Telephone
Fax
Type of Business
Website URL
Email Address
   
Number of Years in Business  
Proprietorship   Partnership   Corporation   Date Incorporated
State of Federal Tax ID
   
Owner(s), Partner(s) or Corporate Officers  
    Title
    Title
    Title
   
Registered Agent
Address
Accounts Payable Manager
Authorized Purchasers
Special Billing Instructions
   
Purchase Order Required? 
Yes  No 		Amount of Credit Desired

 

Bank References  
   
Bank Name
Address
Bank Officer
Telephone
Primary/Operating Account #
Customer Service

 

Trade References    
     
Name Office Use Only

Bank

 High           Days
   
   
   
   
   
   
   
   
Telephone
Address
Fax
   
Name
Telephone
Address
Fax
   
Name
Telephone
Address
Fax
   
Name
Telephone
Address
Fax

 

I hereby certify that all information included in this application is complete and true to the best of my knowledge and I authorize all references, or agents thereof, to release all pertinent information as requested by Illuminations Lighting Design.  I also understand that, according to Illuminations Lighting Design's terms, payment on all invoices is due upon receipt and that the initial order may require a deposit or prepayment and that applicable liens may be applied.

Printed Name
Title
Your initials Here
Date