Credit Account Application Form

Trade-Pro & B2B Application Form

Credit Application - butlerlightingusa.com
Mailing Address

4380 Regency Dr. , High Point, North Carolina, 27265 Phone: (336)-889-2344 Email: accounting@butlerlighting.com
Business Name*
Business Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Previous Address(s):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Address(s):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone:*

Area CodePhone Number
Website:
E-mail:*
Type of Business*

SoleCorporationPartnershipOther
Have You Ever Filed For Bankruptcy?*

NoYes
Are You Bonded?*

NoYes
Use Lien Wavers?*

NoYes
Are You Licensed?*

NoYes
Which State Are You Licensed?*
List Any Other States Your Business Is Licensed:
How Many Years In Business
Whole Numbers Only
Do You Require Purchase Orders?*

NoYes
Bank*

Bank NameBranch
Bank Point Of Contact Name*

Bank NameBranch
Bank Point Of Contact Phone*

Area CodePhone Number
Bank Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Trade/Credit References (At Least 3)*
Printed Full Name*

First NameLast Name
Signature*

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Attach Your First Order Or Any Other Relevant Files:

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We will confirm all information provided and reach out to you at the above contact details!
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