Residential Credit Application

6009 Richmond Ave, Suite 228 Houston, TX 77057
Phone: (800) 239-2939, Fax: (713) 979-1429

Date

Business Information

Legal Company Name

Billing Address

Physical Address (If Different)

Telephone    FAX    Email Address

Type of Business

Number of Years in Business    Proprietorship    Partnership   Corporation

Date Incorporated State of

Federal Tax I.D. Number

Owner(s), Partner(s), or Corporate Officers
                    Title
                    Title
                    Title

Registered Agent                     Address

Accounts Payable Manager

Purchase Order Required? Yes   No    Amount of Credit Desired

Authorized Purchasers

Special Billing Instructions

Bank References

Bank Name    Address

Bank Officer    Telephone

Primary/Operating Account #   Customer Service

Trade References

Name

Telephone

Address

Fax

Office Use Only Bank
High	Days

Name

Telephone

Address

Fax

Name

Telephone

Address

Fax

Name

Telephone

Address

Fax

I hereby certify that all information included in this application is complete and true to the best of my knowledge and I authorize all references, or agents thereof, to release all pertinent information as requested by Residential Landscape Lighting & Design. I also understand that, according to Residential Landscape Lighting & Design's terms, payment on all invoices is due upon receipt and that the initial order may require a deposit or repayment and that applicable liens may be applied.

Printed Name

Title

Your initials Here

Date

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