Customer Credit Application Form
  
   
  APPLICANT'S INFORMATION
       
Company Name:
       
Billing Address:
       
Shipping Address:
       
Phone #:
       
   Fax #:
 
e-Mail Address:
 
Years at Current Address:
 
   
 
Years in Business:
 
 
General Product Lines:
 
 
Type of Industry:
 
State of Incorporation:
      
Resale #:
Company Priciple(s):
 
       
 
TRADE REFERENCES
       
 
1.   Company:
 
 
      Address:
  
 
      City:
  
State:
Zip:
 
      Phone:
  
Fax:
     
 
   
 
2.   Company:
 
 
      Address:
  
 
      City:
  
State:
Zip:
 
      Phone:
  
Fax:
     
       
 
3.   Company:
 
 
      Address:
  
 
      City:
  
State:
Zip:
 
      Phone:
  
Fax:
     
       
 
BANK INFORMATION
       
 
Name of Bank:
 
 
Address:
  
 
Phone:
  
     
     
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   Mail:
   H&M Distributors Inc.
   141 Cassia Way, Suite A
   Henderson, NV 89014
 
   Phone:
   1.702.294.8944
 
   Toll Free:
   1.888.203.6360
 
   Fax:
   1.702.294.8946
 
   Email:
   info@hmlighting.com