Credit Application

AH LIGHTING INC • 2442 Hunter Street, Los Angeles, CA 90021

Questions?

(213) 624-0202

info@ahlighting.com

Billing Information

Company Name

Address

City & Zip Code

Telephone

Fax Number

Email Address / Website

Business Details

Type of Company

Corporation

Partnership

Proprietor

Tax Resale No.

Nature of Business

Year Established

Number of Employees

Office & Warehouse Square Footage

Total Sales Volume / Year

Is Purchase Order Required?

Yes

Officer Name & Title

Social Security # (Secure Encryption Used)

Credit References

Please provide at least 3 professional vendor references

Reference #1

Name & Address

Tel & Fax

Account No.

Reference #2

Name & Address

Tel & Fax

Account No.

Reference #3

Name & Address

Tel & Fax

Account No.

Bank Reference & Authorization

Bank Name

Account No.

Bank Address

Bank Phone

Bank Fax

Authorization Release

"I hereby authorize the release of information to AH Lighting regarding our account for the purpose of credit evaluation. This authorization applies to the company information and bank account numbers provided above."

Printed Name

Position

Date

Credit Terms & Conditions

All invoices are due in full 30 days from the date of the invoice, unless otherwise agreed to.
Returned checks incur a $15.00 fee and terms will revert to C.O.D. Cash/Certified check only.
Visible damage or shortages must be noted on delivery receipt prior to signing.
Claims for damages must be reported within 5 business days of receipt.
No returns accepted without RGA. Returns older than 12 months will not be authorized.
RGA numbers are valid for 60 days only.

Applicant promises to pay for all purchases as billed. Failure to meet payment dates results in a 2% monthly service charge. In event of default, applicant agrees to pay 30% attorney's fees if referred for collection.

I have completely and correctly answered all questions on this application. I authorize AH Lighting to obtain consumer reports for account review now and in the future.

Driver's License No.

Electronic Signature (Type Name)