Credit App - L.A. Woolley Electric, Inc.

CREDIT APPLICATION

Please return the completed application with a copy of your Resale/Reseller/Tax Exemption Certificate

Credit Application

"*" indicates required fields

Phone

This field is for validation purposes and should be left unchanged.

Billing Information

Company Name*

Years In Business

Address*

City*

State*

Zip*

Telephone Number*

Fax Number

Check One

Corporation

Tax ID #

Sole Proprietor

Partnership

Social Security#

Shipping Information

Name*

Address*

City*

State*

Zip*

Telephone Number*

Fax Number

Email Address*

(For Shipment notification)

UPS Collect

FEDEX Collect

Account Number

General Information

Website URL

Invoicing Preference

Mail

Invoice Email Address*

Contact Information

Purchasing

Name

Phone

Fax

Email*

Manager/Branch Manager

Name

Phone

Fax

Accounts Payable

Name

Phone

Fax

Trade References One

Name

Address

City

State

Zip

Phone

Fax

Contact

Trade References Two

Name

Address

City

State

Zip

Phone

Fax

Contract

Trade References Three

Name

Address

City

State

Zip

Phone

Fax

Contact

Trade References Four

Name

Address

City

State

Zip

Phone

Fax

Contact

NOTICE

The above information is for the purpose of obtaining credit and is warranted to be true. I (We) hereby authorize L.A. Woolley Electric, Inc. to whom this application is made to investigate the references listed pertaining to my/our credit and financial responsibility.

CREDIT AGREEMENT

Applicants’ signature attests financial responsibility, ability, and willingness to pay L.A. Woolley Electric, Inc. invoices in accordance with Net 30 Day terms for the purchase of product from L.A. Woolley Electric, Inc.

I (We) hereby certify that I (We) have read this form thoroughly and accept its conditions, and further state that all information supplied by me (us) is true in fact and intent.

Company Name

Applicant Name

Officer / Applicant Signature

Date

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