FIRM NAME NATURE OF BUSINESS
STREET CITY STATE
ZIP TELEPHONE A/P CONTACT
LENGTH OF TIME IN BUSINESS CORP PARTNERSHIP
INDIVIDUAL
SUBSIDIARY OR DIVISION OF
PRINCIPAL NAME RESIDENTIAL ADDRESS: STREET/CITY/ST/ZIP SOCIAL SECURITY#
PURCHASES ARE TAXABLE OR ATTACH EXEMPT CERTIFICATE. EXEMPT #
BANK REFERENCE
TEL NO PERSON TO CONTACT
THREE (3) BUSINESS REFERENCES: Please fill out completely to speed credit
NAME TEL NO.
ADDRESS CONTACT
NAME TEL NO
I personally guarantee payment of all amounts due to J. & H. Magerman, Inc. and agree to the terms stated on the invoice. I understand that a 2.5% finance charge will be added to each invoice open past 30 days. I give the above information for the purpose of obtaining credit from 3-D Lighting and hereby authorize that credit information be given to 3-D Lighting upon their request.
