CREDIT APPLICATION

Please complete all of the fields below and click submit at the bottom of the page for your credit application to be processed.

COMPANY INFORMATION

Company Name

PO Box

Ship To Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

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####

Fax

(###)

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Social Security Number

Sales Tax

Federal ID

Exemption Number

Names of Principals in Company

Buyer's Name

Buyer's Email Address

Accounts Payable Contact Name

Accounts Payable Email Address

Type of Business

Date Business Started

Bank Name and Address

Business Structure

Show Prices on Sales Order

Yes

PO Required

Yes

TRADE REFERENCES

Name

Phone

(###)

###

####

Fax

(###)

###

####

City, State, Zip

Name

Phone

(###)

###

####

Fax

(###)

###

####

City, State, Zip

Name

Phone

(###)

###

####

Fax

(###)

###

####

City, State, Zip

Name

Phone

(###)

###

####

Fax

(###)

###

####

City, State, Zip

OTHER INFORMATION

Approximate Anticipated Purchases Per Month

If required, may we have a copy of your financial statements?

Yes

AUTHORIZED SIGNATURES

We understand and agree to meet Holder Electric Supply's terms of sale, to pay service charges assessed, and to pay reasonable attorney fees and cost of collection in the event of default. The undersigned individual who is either a principal of the credit applicant or a sole proprietorship of the credit applicant, recognizing that his or her individual credit history may be a factor in the evaluation of the credit history of the applicant, herby consents to and authorizes the use of a consumer credit report on the undersigned by the above named credit grantor, from time to time as may be needed, in the credit evaluation process. Controlling law of this agreement shall be South Carolina law. Both parties additionally agree any further litigation shall be in the state of South Carolina in Greenville County. By typing my full name in the box below, I am consenting for my name to serve as my signature. *Service charges of 1.5% will be charged on all past-due invoices. Merchandise not to be returned without written permission. We agree to adhere to these terms. A personal guaranty may be required.

Signature by Company Officer

Title

Signature by Company Principal

Title

Date

YYYY

PERSONAL GUARANTEE

Instructions for submitting form. Click on the button below.

Sign Personal Guarantee