Customer Information Form

Business Contact Information

Company Name *

Primary Contact

Name *

Email *

Direct Contact Phone *

Accounts Payable Contact

Name

Email

Direct Contact Phone

Company

Registered Company Address *

Main Phone Number *

Date Business Commenced

How Long at Current Address?

Type of Business Entity *

Sole Proprietorship

Partnership

Corporation

LLC

Other

Who is Authorized to Request Service?

Billing

P.O.s Required?

Yes

No

ACH Information Requested?

Yes

No

Method of Payment

ACH

Check

Credit Card

Special Billing Requests

Payment is due on receipt of invoice unless approved for a business credit account as indicated below. Claims arising from invoices must be made within seven days of receipt of invoice.

Credit Terms Requested. Complete the credit application below.

Please also send a completed W-9 to contact@columbusdaylighting.com.

Credit Application

All invoices must be paid 30 days from the date of service.
By submitting this application, you authorize Columbus Daylighting to make inquiries into the business/trade references that you have supplied.

Bank

Bank Name

Direct Contact Name

Direct Contact Email

Direct Contact Phone

Credit Line Requested?

Who should be contacted for late payment inquiries?

Business/Trade References

Business Name

Name & Contact

Direct Contact Email

Direct Contact Phone

Business Name

Name & Contact

Direct Contact Email

Direct Contact Phone

Business Name

Name & Contact

Direct Contact Email

Direct Contact Phone

Authorization & Signature

Typing your name below acts as your signature and confirms the information above is accurate. If you requested credit terms, it also confirms the credit application and reference authorization.

Signature (type your full name) *