Avi-on Credit Application Form

Please provide your contact information
Your company name*
What type of organization do you represent?*

AgentESCODistributorInstaller, electrician, or contractorLighting controls customer or userOEM fixture manufacturerOther
Your Name*

First NameLast Name
Your Phone Number*
Please enter a valid phone number.
1) Requested Payment Terms*
This selection confirms contract payment terms and understanding that failure to pay on time will impact future payment terms.
2) Please attach your company's W9.*

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3) Please download the Avi-on Credit Application and W9 on THIS LINK. Once completed, please upload the PDF at right.
4) Please upload the completed Avi-on Credit Application form below.*

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5) FOR TAX EXEMPT STATUS ONLY. Please upload your tax exempt certificate, or resale certificate, if applicable

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6) Name of Accounts Payable (AP) person at your company who will manage the Avi-on Account*

First NameLast Name
7) AP Email Address. This is the address that we will invoice.*
example@example.com
8) AP Phone Number*
Please enter a valid phone number.
Please verify that you are human*
Should be Empty: