Credit Application Form

Step 1 of 5

Please accurately complete the Credit Application Form below.

If you have questions, contact WorkSite Lighting Customer Support at 877-861-5255 or [email protected].

Business Information

Business Name

Business Email(Required)

Business Phone(Required)

Business Fax #

Type of Business(Required)

Date Business Started(Required)

Organization Type

Corporation

Partnership

Sole Proprietorship

LLC

Federal ID (TIN #)(Required)

D&B #

Business Address

Street Address City State / Province / Region ZIP / Postal Code Country

Annual Sales(Required)

Total Assets(Required)

Number of Employees(Required)

A/P Email(Required)

Name(s) of Owners or Authorized Officers(Required)

1st Trade Reference

Name(Required)

Email(Required)

Phone(Required)

Address

Street Address City State / Province / Region ZIP / Postal Code Country

2nd Trade Reference

Name(Required)

Email(Required)

Phone(Required)

Address

Street Address City State / Province / Region ZIP / Postal Code Country

3rd Trade Reference

Name(Required)

Email(Required)

Phone(Required)

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Credit Application Form

Please accurately complete the Credit Application Form below.

Business Information

Sales/Use Tax Information

1st Trade Reference

2nd Trade Reference

3rd Trade Reference

Bank Reference

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