North American Lighting Products Credit Application

Thank you for your interest in creating an account with North American Lighting Products. Please complete the following in it's entirety and we will review the application and contact you shortly. Because this is an electronic submission, your check mark below will serve as your electronic signature. North American Lighting Products reserves the right to request a completed application form and actual signature under separate cover.

In making this application for credit, we agree to pay all invoices within 30 days from date of invoice and to pay a service charge of 1.5% per month (annual rate of 18%) on all overdue balances.

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Date of Application*

Credit Limit Requested*

Sales Representative*

Legal Company Name*

Doing Business As:

Business Address:*

Mailing Address:

Telephone Number:*

Fax Number:

Cellular Phone Number:*

Email:*

Company Website:*

D&B Number::

Type of Business:*

Years in Business:*

Years At Present Location:*

Type of Organization:

Please select one __________________________ Private Corporation Public Corporation Partnership Individual / Sole Proprietorship

Signing Officer 1:*

Signing Officer 2:*

Signing Officer 3:*

Banking Reference:*

Trade Reference 1:*

Trade Reference 2:

Trade Reference 3:*

Name:

Title:*

Terms Agreement:*

In making this application for credit, we agree to pay all invoices within 30 days from date of invoice and to pay a service charge of 1.5 % per month (annual rate of 18%) on all overdue balances.

Electronic Signature:*

By selecting this box, I verify that I have authority to sign legally binding contracts on behalf of the company described herein. Furthermore, I authorize North American Lighting Products to perform all necessary credit checks in completing its due diligence of this credit application.

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