D-Lighting Illusions, Inc.
11659 Jones Road PMB 351
Houston, Texas 77070-5903
local 281-469-2800
toll free 866-508-4455
NEW CUSTOMER APPLICATION
All New Customers
*FIRM
NAME:________________________________________________ *Tel.
No.:_____________________________________
*Fax No.:____________________________________
*E-mail: _____________________________________
*TAX
EX.NO.:__________________________________________
*FIN
#:_____________________________________________
*BILLING
ADDRESS:_______________________________________________________________________________________
*SHIPPING
ADDRESS:______________________________________________________________________________________
************************************************************************************************************
YR.
EST.:________ CORP.:________ DATE INC.:__________ PART:_________
SOLE OWN:________ LLC:_________
PRIN.
OWN.:_______________________________________________________________________________________________
ADDRESS:
___________________________________________ ___________________
PHONE:__________________________
TYPE
OF BUSINESS:___________________________________________ ANN. SALES VOL.:__________________________
OWN:__________
RENT:__________ # OF EMP.:___________ D&B
RATE:_____________
BANK
REFERNCE
NAME:__________________________________________________________
CONTACT:_______________________________
TEL:______________________________
ADDRESS:_____________________________________________________________
ACC.
NO.:_______________________________
TRADE
REFERENCES
NAME:______________________________________________________________
CONTACT:__________________________
ADDRESS:__________________________________________________________________________
ZIP:__________________
ACCT.
NO.:________________ TEL:______________________________
FAX:_______________________________________
NAME:______________________________________________________________
CONTACT:__________________________
ADDRESS:__________________________________________________________________________
ZIP:__________________
ACCT.
NO.:________________ TEL:______________________________
FAX:_______________________________________
NAME:______________________________________________________________
CONTACT:__________________________
ADDRESS:__________________________________________________________________________
ZIP:__________________
ACCT.
NO.:________________ TEL:__________________
FAX:_______________
The
above information as set forth is presented for the purpose of obtaining
merchandise and services from H & H Manufacturing on credit and H & H
Mfg. may rely on it as being true and correct.
We hereby authorize the above listed references to release any
information requested of them necessary to establish a line of credit with H
& H Mfg. Inc. in consideration of the extension of credit, the undersigned
unconditionally guarantees the prompt payment of the entire balance due and
consents to be bound by all the terms and conditions including but not limited
to reasonable attorney’s fees, cost of collection and interest at the rate of
1 ½% per month on any unpaid balance. Applicant’s
signature attests financial responsibility, ability and willingness to pay
H & H Manufacturing Inc. invoices in accordance with H & H Mfg.
Terms.
SIGNATURE:_____________________________________________
PRINT NAME:___________________________________
DATE:_______________________________SS
# :_____________________________
CREDIT
DEPT USE
FAX
TO 256-357-9885
CUSTOMER
NO.:_________________ SALES REP
NO:_____________
(MAIL ORIGINAL)
*
Denotes info. Required of all Customers