LEDTRONICS CREDIT VERIFICATION FORM


There are two ways to submit this form; either by submitting online the form below, or printing out the blank form, filling it out, and faxing to (310) 534-1424. The fields marked with a red asterisk (*) are required. Security is a top priority at LEDtronics.com. Any sensitive information submitted to LEDtronics is encrypted and protected with the most advanced form of SSL software available: 128-bit encryption.

Required Forms
These are required Tax Resale Certificate forms of which LEDtronics needs a signed copy. If these apply to your business, please print out and complete the appropriate form. Fax the signed copy back to us at 310-534-1424 for processing.

CA Resale Certificate - Texas Resale Certificate - TX Exemption Certificate - General Resale Certificate


Company Information
Company Name*
Contact*
Title*
Email Address*
Company Address*
Billing Address
(if different)
Phone Number*
Fax Number
Federal Taxpayer ID*
California State Corporate ID #
Dun & Bradstreet #
Corporation
Partnership
Sole Proprietorship
Social Security #
First Bank Reference
Bank Name*
Bank Account #*
Bank Contact
Phone Number*
Fax Number

Second Bank Reference
Bank Name
Bank Account #
Bank Contact
Phone Number
Fax Number

Credit References (Please list four credit references)
(1)Company Name*
Address*
Phone Number*
Fax Number*
Contact Individual*


(3)Company Name
Address
Phone Number
Fax Number
Contact Individual
 
(2)Company Name
Address
Phone Number
Fax Number
Contact Individual


(4)Company Name
Address
Phone Number
Fax Number
Contact Individual
12 month financing available on approved credit. Check here for LEDtronics representative to contact you.
 
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