Emergency Light Batteries.com Credit Application

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Name *
E-mail Address *
Company Name *
Type of Entity *
Billing Address *
City, State & Zip Code *
Phone Number *
Fax Number
Duns Number
Federal Tax ID Number
Banking Reference *
Bank Address (Including City, State & Zip Code) *
Bank Contact Name and Phone Number *
Account Number *
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Supplier currently extending credit - Please include company name, address, contact person & phone number *
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Terms of sale: Upon granting credit, payment is due within 30 days of invoice date. Payable only in U.S. funds. Overdue accounts will be subject to a 2% per month service charge. Emergency Light Batteries reserves the right to collect reasonable legal and filling fees, court costs and any other expenses that may incur in order to collect an account that must be placed with a third party.