Credit Application

* Required

General
* Name:
* Company:
* Address 1:
Address 2:
Mailing Address (if different):
* City, State, Zip: ,
* Phone:
Fax:
Email:
Company Information
* Type of Business:
Business Address:
* Date Established
* # of Employees:
* Entity Type:
  • Sole Proprietorship
  • Partnership
  • Corperation
* SS# or FID#:
Electrician's License #:
State:
* Credit Limit Requested:

Name and Title of Owners/Partners/Officers

* Name:
* Title:
Name:
Title:
Name:
Title:

Contact Person

* Contact Name:
* Contact Phone:
References

Bank Reference

* Contact Name:
* Contact Phone:
Fax:

Trade References

* Contact Name:
* Contact Phone:
Fax:
Contact Name:
Contact Phone:
Fax:
Contact Name:
Contact Phone:
Fax: