CREDIT APPLICATION


DISTRIBUTOR ACCOUNT APPLICATION
Tel
Tel
Fax
Fax
Contact
Contact
Billing Address
Billing Address
Accounts Payable Contact #
Accounts Payable Contact #
Accounts Payable Phone #
Accounts Payable Phone #
Type of Business :
* If you are tax exempt, provide certificate or sales will be taxed. A resale certificate is required, No exceptions.
BUSINESS TRADE REFERENCES
* Email of Fax number must be provided to process the credit inquiry.
Contact
Contact
Tel #
Tel #
Fax #
Fax #
Contact
Contact
Tel #
Tel #
Fax #
Fax #
Contact
Contact
Tel #
Tel #
Fax #
Fax #
Radio
BANK REFERENCES
Name *
Name
Tel
Tel
Fax
Fax
Contact
Contact
I authorize the above references and bank to release relevant credit information to UTOPIA LIGHTING, Inc.
Name
Name
Date
Date
We reserve the right to add to your monthly balance, a service change of 1/12% per month (18% annual rate) on all amounts unpaid on the first day of the 2nd month following purchase. If this account is placed with a third party for collection, buyer agrees to pay all costs and expenses of collection including the reasonable attorneys fees in addition to the service charges stated above.
PLEASE MAIL THE ORIGINAL SIGNED APPLICATION AND FAX RESALE PERMIT & COPY TO : (310) 327-5711