Credit Terms Application

5053 Lee Highway

Arlington, VA 22207

Ph: (703) 536-4400; Email: ar@dominionelectric.com

Applicant Name

Correo electrónico

What is your role at the company?

Nombre de la empresa

Dirección

Dirección (línea 1)

Ciudad

Provincia

Código Postal

What branch do you plan on purchasing materials from?

What is the primary market your company serves?

SSN What let

What is your annual spend estimated spend on materials?

For which credit terms are you applying?

Business TIN (OR SSN if sole proprietor)

Please let us know your primary purpose for applying for credit with Border States

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