Skip to content
Home
Who We Are
Vision & Culture
Leadership
History
Careers
Business Resources
Product Lines
Products
Divisions
Supply Counters
Commercial Lighting
Switchgear Power Distribution
Material Sales
Services
Residential Lighting
Locations
Contact
Menu
Home
Who We Are
Vision & Culture
Leadership
History
Careers
Business Resources
Product Lines
Products
Divisions
Supply Counters
Commercial Lighting
Switchgear Power Distribution
Material Sales
Services
Residential Lighting
Locations
Contact
Bill Pay
Shop Now
Credit Application
Credit Application
APPLICATION FOR BUSINESS CREDIT
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
CUSTOMER INFORMATION
LEGAL BUSINESS NAME and DBA, if applicable
*
SHIPPING ADDRESS
Address Line 1
City
STATE
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
BILLING ADDRESS
Address Line 1
City
STATE
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
TELEPHONE NUMBER
CELL NUMBER
TYPE OF BUSINESS
BUSINESS STRUCTURE
Type of Business Structure
CORPORATION
LLC
PARTNERSHIP
PROPRIETORSHIP
OTHER
If Other
FED TAX#
SS#
NUMBER OF EMPLOYEES
OWNER/PRESIDENT
PURCHASING AGENT
IN BUSINESS SINCE
ENGINEERING DEPT
MAINTENANCE DEPT
LICENSING INFORMATION
ELECTRICIANS LICENSE #
NAME
(MASTER OR CLASS B)
TYPE
STATE
CREDIT REQUEST
AMOUNT OF MONTHLY CREDIT REQUESTED
ACCOUNTS PAYABLE CONTACT PERSON
TRADE REFERENCES
FIRM NAME
Single Line Text
Single Line Text (copy) (copy)
Single Line Text (copy) (copy) (copy)
Single Line Text (copy) (copy) (copy) (copy)
ADDRESS
Single Line Text
Single Line Text (copy)
Single Line Text (copy) (copy)
Single Line Text (copy) (copy) (copy)
PHONE
Single Line Text (copy)
Single Line Text (copy) (copy)
Single Line Text (copy) (copy) (copy)
Single Line Text (copy) (copy) (copy) (copy)
EMAIL
Single Line Text (copy)
Single Line Text (copy) (copy) (copy)
Single Line Text (copy) (copy) (copy) (copy)
Single Line Text (copy) (copy) (copy) (copy) (copy)
BANK REFERENCE
BANK
CITY
STATE
CONTACT PERSON
CHECKING PERSON ACCT#
PHONE #
ROUTING NUMBER
SALES TAX
SALES TAX TO BE CHARGED?
YES
NO
IF “NO,” PLEASE COMPLETE AND SIGN A SALES TAX EXEMPTION CERTIFICATE AND RETURN WITH THIS APPLICATION.
OFFICE USE
BRANCH#
CUSTOMER GROUP
SR
APPROVAL BR MGR
SALES TERRITORY
PRICE LEVEL
TRANS ZONE
ARE YOU SUBJECT TO A CITY OR COUNTY TAX?
YES
NO
ARE YOU SUBJECT TO A CITY OR COUNTY TAX?
Invoices are emailed.
Please provide the email address of your Accounts Payable department:
*
TERMS AND CONDITIONS OF CREDIT
In consideration for Border States Industries, Inc., dba Border States, Border States Electric and Chapman Metering, (“Company”) permitting the undersigned individual or entity (“Applicant”) to purchase materials from the Company, the Applicant agrees that the following terms and conditions shall control with respect to all business dealings, determinations and sales:
1 . The person(s) signing this credit application (“Application”) warrants and represents to the Company that they have full authority to enter into this Application on behalf of the Applicant. Applicant represents that all materials purchased from the Company are for agricultural, business or commercial purposes only and not for personal, family or household purposes. The Applicant understands that the submittal of this Application does not constitute a credit account until approved by the Company.
2. Applicant agrees to pay for all materials purchased from the Company by the due date according to the terms of sale stated on each invoice or as otherwise agreed to in writing between the Applicant and the Company. All accounts are due and payable at the address shown on the Company's invoice. Credit availability shall be at the sole discretion of the Company and may be terminated or changed at any time by the Company. The Company specifically reserves the right to require payment in cash for any shipment or delivery should the Company so determine.
3. Applicant agrees to pay late payment fees on all past due amounts at a rate of 1.5% per month, but not to exceed the highest rate lawfully allowed in the state in which this Application is executed. Acceptance of any payment from Applicant without the accrued interest included shall not be deemed to be a waiver of such accrued interest.
4. To the extent allowed by applicable law, the Applicant agrees to pay all costs of collection incurred by the Company relating to this Application or the Applicant's account, including reasonable attorneys' fees, expert witness fees and costs, without regard to whether a lawsuit or arbitration is commenced. The law of the state where the Company’s branch office with primary responsibility for servicing the Applicant is located shall govern. Any action arising out of or relating to this Application or disputes concerning the Applicant's account commenced by the Applicant shall be brought by the Applicant in the county and state where the Company’s office with the primary responsibility for serving Applicant is located. This choice of law and venue provision is a negotiated term and an integral part of the bargained for consideration for this Application.
5. Company's Terms and Conditions of Sale apply to all transactions between Company and Applicant and are incorporated herein by reference. These terms are located at www.borderstates.com and may be updated as necessary by Company. No terms or conditions or purchase orders of the Applicant that are different from the Company terms will become part of any contract unless approved in writing and signed by an Officer of the Company.
6. As security for the payment obligations of the Applicant owing the Company under any outstanding invoice, the Applicant hereby grants to the Company a security interest in the goods described in such invoice or invoices, together with the proceeds thereof. The Applicant agrees to provide the Company with such financing statements and other documents as the Company may request in order to perfect its security interest. In addition, the Applicant appoints the Company as its attorney-in-fact to execute and file any such financing statement or statements necessary to perfect the Company’s security interest. Company retains all rights, as appropriate and necessary, to file mechanics liens, bond rights and file lawsuit for payment.
7. The Company is hereby authorized to investigate the references listed in this Application pertaining to the credit and financial responsibility of the Applicant. As often as the Company may request, the Applicant will provide financial statements and such other financial information of the Applicant (and any guarantor of Applicant’s account) as the Company shall request from time to time. In addition, the Company is authorized to obtain, from time to time, credit reports on the Applicant. The undersigned hereby consent(s) to the Company’s use of a non-business consumer credit report on the undersigned in order to further evaluate the credit worthiness of the undersigned as principal(s), proprietor(s) and/or guarantor(s) in connection with the extension of business credit as contemplated by this Application. The undersigned hereby authorize the Company to utilize a consumer credit report on the undersigned from time to time in connection with the extension or continuation of the business credit represented by this Application. The undersigned as [an] individual(s) hereby knowingly consent(s) to the use of such credit report consistent with the Federal Fair Credit Reporting Act as contained in 15 U.S.C. ¶ 1681 et. seq.
Name Printed
Name Printed
Signature
Clear Signature
Signature
Clear Signature
Social Security Number
Social Security Number
8. In the event of any change in character of ownership of the Applicant's business whether by incorporation or otherwise, by addition of partners, members or any other change in the ownership interest of the Applicant, Applicant shall immediately notify Company. Any change not relayed to Company may be grounds for a breach of this agreement and Application and Company may revoke any and all credit terms. The Company will rely on the information provided in the Application until notified by Applicant to the contrary. Any notice contemplated by this paragraph shall be sent by the Applicant, by certified mail, return receipt requested, to the Company at the address shown on the then most current invoice.
By signing below, the Applicant acknowledges its agreement to these Terms and Conditions of Credit, and the individual signing on behalf of the Applicant warrants that they are signing with full and complete authority to bind Applicant.
Name of company or entity
Signed by:
Title:
Name Printed:
Date:
PERSONAL GUARANTEE
The undersigned, whether one or more, jointly and severally, as an inducement to the Company to extend credit terms, do hereby unconditionally guarantee the payment of any and all obligations, debts and/or liabilities (including interest and attorneys' fees) of the Applicant, which have in the past or may in the future be owing the Company on open account or otherwise under the same conditions. The obligations under this guarantee are primary and independent of the Applicant’s obligations, and the undersigned waive: (1) any right to require the Company to proceed against Applicant or pursue any other remedy and any statute of limitations pertaining thereto; (2) diligence, demand, presentment for payment and protest; (3) the application of any statutory provisions requiring joinder or limiting the liability of a surety, endorser or guarantor; and (4) notice of any extension, forgiveness, re-structuring or modification of Applicant’s present or future indebtedness to the Company.
The undersigned hereby consent(s) to the Company’s use of a non-business consumer credit report on the undersigned in order to further evaluate the credit worthiness of the undersigned as principal(s), proprietor(s) and/or guarantee(s) in connection with the extension of business credit as contemplated by this Application. The undersigned hereby authorizes the Company to utilize a consumer credit report on the undersigned from time to time in connection with the extension or continuation of the business credit represented by this Application. The undersigned as (an) individual(s) hereby knowingly consent(s) to the use of such credit report consistent with the Federal Fair Credit Reporting Act as contained in 15 U.S.C. ¶ 1681 et. seq. If the undersigned lives in the following states: Alaska, Arizona, Arkansas, California, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont, Virginia, Washington, Wisconsin or Wyoming, the undersigned may be required to provide the signature of their spouse in addition to their own signature before the Company extends credit terms.
Dated this
day of
Name Printed:
Social Security Number:
Signed:
Clear Signature
Address:
Name Printed:
Social Security Number:
Signed:
Clear Signature
Address:
GUARANTOR MAY REVOKE THIS GUARANTEE AS TO FUTURE TRANSACTIONS ONLY BY SERVING WRITTEN NOTICE UPON THE COMPANY, BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED, AT THE ADDRESS THAT THE ACCOUNT IS MANAGED. RECEIPT OF SUCH NOTIFICATION WILL NOT RELIEVE GUARANTOR OF ITS GUARANTEE LIABILITY BY THE COMPANY FOR ANY ORDERS ACCEPTED BY THE COMPANY ON OR BEFORE THE DAY THE COMPANY RECEIVES SAID REVOCATION.
Submit
English
Spanish
English
Skip to content
Open toolbar
Accessibility Tools
Accessibility Tools
Increase Text
Increase Text
Decrease Text
Decrease Text
Grayscale
Grayscale
High Contrast
High Contrast
Negative Contrast
Negative Contrast
Light Background
Light Background
Links Underline
Links Underline
Readable Font
Readable Font
Reset
Reset