ExceLine - Architectural Indoor Lighting Systems

Credit Application


Full Name of Firm:
Address:
City:
State:
Zip:
Phone:
FAX:
Name of Owner or Officer:
Home Address:
City:
State:
Zip:
Home Phone:
SS#:

I, the undersigned, as an inducement to grant credit, warrant that the information is true and correct, and further authorizes the named references to share the applicant's credit history with the Genlyte Group. If credit is granted (standard terms are 1%-10 days-Net 30 days), I agree to abide by the terms. I understand if my account becomes delinquent, credit terms will be revoked, and all future purchases will be on a cash basis only. Applicant agrees to pay any collection costs incurred to collect severely delinquent balances, including reasonable attorney fees.

Executed this day of 20

Signature: ________________________________________________

Printed Name: ___________________ Title: _____________________

The Genlyte Group

Rep Name:
Rep No.:
Resale Certificate No.:
Business Identity:	Sole Proprietorship Corporation	Partnership Other
How long in Business:	Less than 1 year 3-5 yrs 10+ yrs	1-2 yrs 6-10 yrs
How long under present ownership:	Less than 1 year 3-5 yrs 10+ yrs	1-2 yrs 6-10 yrs
Are your accounts receivable and/or inventory secured? yes no
By whom?
Buying Group Affiliation:

The above information as well as that given on page two of this application is for the purpose of obtaining credit and is warranted to be true. I/we hereby authorize the firm to whom this application is made to verify information on me/us, including requesting reports from credit reporting agencies. If I ask whether or not a personal credit report was requested, you will tell me; if you receive a report you will give me the name and address of the agency that furnished it.


TRADE REFERENCES List only those suppliers from whom you buy on open account

1.	Name:
	Address:
	City:
	State:
	Zip:
	Acct.#
	Phone:
	Fax:

2.	Name:
	Address:
	City:
	State:
	Zip:
	Acct.#
	Phone:
	Fax:

3.	Name:
	Address:
	City:

	Zip:
	Acct.#
	Phone:
	Fax:

4.	Name:
	Address:
	City:

	Zip:
	Acct.#
	Phone:
	Fax:

BANK REFERENCE
Bank Name:
Acct. Officer:
Address:
Savings Acct.#:
Checking Acct.#
Phone:
Loan Acct.#:
While submitting this application electronically will expedite opening your account, we will still require a signed hard copy prior to your account being opened.

ExceLine is a member of the Philips Group