Customer Set up Request Customer Name* Physical Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Tax Exempt*NoYesTax Exempt FileMax. file size: 100 MB.Accounts Payable Contact* First Last Accounts Payable Phone:*Accounts Payable email Accounts Payable mailing address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Would you like invoices and statements emailed?*YesNoPrincipal/Owner* Principal/Owner Phone Number*Principal/Owner email* Trade Reference #1* First Last Trade Reference Email #1* Trade Reference Phone #1*Trade Reference #2* First Last Trade Reference Email #2* Trade Reference Phone #2*Trade Reference #3* First Last Trade Reference Email #3* Trade Reference Phone #3*Locations to service*Attach list if needed. D&B # Attach location list Drop files here or Select files Max. file size: 100 MB. Referred by:Web SearchCustomer ReferralPaul MooreDavid BaileyRamon GarciaTommy RudererTimber JappDylan HuertaOtherForm filled out by:* First Last PhoneForm filled out by email:* Consent* I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein. I also agree to the payment terms NET 15 days, 1.5% late fees to accrue after 30 days past due, unless other written agreement has been determined.Dalworth Lighting & Electrical Services, LLC is regulated by the Texas Department of Licensing and Regulation TECL 32286 Dalworth Lighting & Electrical Services, LLC is regulated by the Texas Department of Licensing and Regulation TECL 32286CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
