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data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-d73709e\" data-id=\"d73709e\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c0ba002 elementor-widget elementor-widget-heading\" data-id=\"c0ba002\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Credit Application<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1092e06 elementor-section-content-middle elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1092e06\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-4bb1dfa\" data-id=\"4bb1dfa\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-fe5eef4 elementor-widget elementor-widget-image\" data-id=\"fe5eef4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"230\" height=\"46\" src=\"https:\/\/dominionelectric.com\/wp-content\/uploads\/2023\/05\/dominion-logo-white.svg\" class=\"attachment-large size-large wp-image-52\" alt=\"Dominion Logo\" title=\"\">\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-1ba37b5\" data-id=\"1ba37b5\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d725de6 elementor-widget elementor-widget-heading\" data-id=\"d725de6\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">APPLICATION FOR BUSINESS CREDIT<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-51d9700 elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"51d9700\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-ec4f447\" data-id=\"ec4f447\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c81b3ae uael-wpf-style-box uael-wpf-input-size-sm uael-wpf-button-left uael-wpf-btn-size-sm uael-wpf-highlight-style-default elementor-widget elementor-widget-uael-wpf-styler\" data-id=\"c81b3ae\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;wpf_input_padding&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;wpf_input_padding_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;wpf_input_padding_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;wpf_input_radius&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;0&quot;,&quot;right&quot;:&quot;0&quot;,&quot;bottom&quot;:&quot;0&quot;,&quot;left&quot;:&quot;0&quot;,&quot;isLinked&quot;:true},&quot;wpf_input_radius_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;wpf_input_radius_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;wpf_button_align&quot;:&quot;left&quot;,&quot;wpf_button_padding&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;wpf_button_padding_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;wpf_button_padding_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;btn_border_radius&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;btn_border_radius_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;btn_border_radius_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;form_fields_margin&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;form_fields_margin_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;form_fields_margin_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;form_label_margin_bottom&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;form_label_margin_bottom_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;form_label_margin_bottom_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;form_desc_margin_top&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;form_desc_margin_top_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;form_desc_margin_top_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;check_radio_items_spacing&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;check_radio_items_spacing_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;check_radio_items_spacing_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;submit_spacing&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;submit_spacing_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;submit_spacing_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]}}\" data-widget_type=\"uael-wpf-styler.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class = \"uael-wpf-container\">\n\t\t\t\t\t\t<div class = \"uael-wpf uael-wpf-style elementor-clickable\">\n\t\t\t\t\t\t<style id=\"wpforms-css-vars-3282\">\n\t\t\t\t#wpforms-3282 {\n\t\t\t\t\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-3282\"><form id=\"wpforms-form-3282\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"3282\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/es\/wp-json\/wp\/v2\/pages\/3286\" data-token=\"60e24b1ce53f347399a732ca349e54b9\" data-token-time=\"1776233754\"><noscript class=\"wpforms-error-noscript\">Por favor, activa JavaScript en tu navegador para completar este formulario.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Por favor, activa JavaScript en tu navegador para completar este formulario.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-3282-field_1-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"1\"><div id=\"wpforms-3282-field_1\" aria-errormessage=\"wpforms-3282-field_1-error\"><h2>CUSTOMER INFORMATION<\/h2><\/div><\/div><div id=\"wpforms-3282-field_2-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_2\">LEGAL BUSINESS NAME and DBA, if applicable <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3282-field_2\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][2]\" aria-errormessage=\"wpforms-3282-field_2-error\" required><\/div><div id=\"wpforms-3282-field_87-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"87\"><fieldset><legend class=\"wpforms-field-label\">SHIPPING ADDRESS<\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-3282-field_87\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][87][address1]\" placeholder=\"ADDRESS\" aria-errormessage=\"wpforms-3282-field_87-error\" ><label for=\"wpforms-3282-field_87\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Direcci\u00f3n (l\u00ednea 1)<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-3282-field_87-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][87][city]\" placeholder=\"CITY\" aria-errormessage=\"wpforms-3282-field_87-city-error\" ><label for=\"wpforms-3282-field_87-city\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Ciudad<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-3282-field_87-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][87][state]\" aria-errormessage=\"wpforms-3282-field_87-state-error\" ><option class=\"placeholder\" value=\"\" selected disabled>STATE<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >Distrito de Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawai<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Luisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >M\u00edchigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Misisip\u00ed<\/option><option value=\"MO\" >Misuri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >Nuevo Hampshire<\/option><option value=\"NJ\" >Nueva Jersey<\/option><option value=\"NM\" >Nuevo M\u00e9xico<\/option><option value=\"NY\" >Nueva York<\/option><option value=\"NC\" >Carolina del norte<\/option><option value=\"ND\" >Dakota del norte<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oreg\u00f3n<\/option><option value=\"PA\" >Pensilvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >Carolina del Sur<\/option><option value=\"SD\" >Dakota del Sur<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >Virginia Occidental<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-3282-field_87-state\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Provincia<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-3282-field_87-postal\" class=\"wpforms-field-address-postal wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][87][postal]\" placeholder=\"ZIP\" aria-errormessage=\"wpforms-3282-field_87-postal-error\" ><label for=\"wpforms-3282-field_87-postal\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">C\u00f3digo Postal<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-3282-field_88-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"88\"><fieldset><legend class=\"wpforms-field-label\">BILLING ADDRESS<\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-3282-field_88\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][88][address1]\" placeholder=\"ADDRESS\" aria-errormessage=\"wpforms-3282-field_88-error\" ><label for=\"wpforms-3282-field_88\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Direcci\u00f3n (l\u00ednea 1)<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-3282-field_88-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][88][city]\" placeholder=\"CITY\" aria-errormessage=\"wpforms-3282-field_88-city-error\" ><label for=\"wpforms-3282-field_88-city\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Ciudad<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-3282-field_88-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][88][state]\" aria-errormessage=\"wpforms-3282-field_88-state-error\" ><option class=\"placeholder\" value=\"\" selected disabled>STATE<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >Distrito de Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawai<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Luisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >M\u00edchigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Misisip\u00ed<\/option><option value=\"MO\" >Misuri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >Nuevo Hampshire<\/option><option value=\"NJ\" >Nueva Jersey<\/option><option value=\"NM\" >Nuevo M\u00e9xico<\/option><option value=\"NY\" >Nueva York<\/option><option value=\"NC\" >Carolina del norte<\/option><option value=\"ND\" >Dakota del norte<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oreg\u00f3n<\/option><option value=\"PA\" >Pensilvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >Carolina del Sur<\/option><option value=\"SD\" >Dakota del Sur<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >Virginia Occidental<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-3282-field_88-state\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Provincia<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-3282-field_88-postal\" class=\"wpforms-field-address-postal wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][88][postal]\" placeholder=\"ZIP\" aria-errormessage=\"wpforms-3282-field_88-postal-error\" ><label for=\"wpforms-3282-field_88-postal\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">C\u00f3digo Postal<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-3282-field_4-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"4\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-3282-field_7-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_7\">TELEPHONE NUMBER<\/label><input type=\"tel\" id=\"wpforms-3282-field_7\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][7]\" aria-label=\"TELEPHONE NUMBER\" aria-errormessage=\"wpforms-3282-field_7-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-3282-field_89-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"89\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_89\">CELL NUMBER<\/label><input type=\"tel\" id=\"wpforms-3282-field_89\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][89]\" aria-label=\"CELL NUMBER\" aria-errormessage=\"wpforms-3282-field_89-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-3282-field_90-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"90\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_90\">TYPE OF BUSINESS<\/label><input type=\"text\" id=\"wpforms-3282-field_90\" class=\"wpforms-field-large\" name=\"wpforms[fields][90]\" aria-errormessage=\"wpforms-3282-field_90-error\" ><\/div><div id=\"wpforms-3282-field_10-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"10\"><div id=\"wpforms-3282-field_10\" aria-errormessage=\"wpforms-3282-field_10-error\"><h2>BUSINESS\r\nSTRUCTURE<\/h2><\/div><\/div><div id=\"wpforms-3282-field_12-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"12\"><fieldset><legend class=\"wpforms-field-label\">Type of Business Structure<\/legend><ul id=\"wpforms-3282-field_12\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3282-field_12_1\" name=\"wpforms[fields][12][]\" value=\"CORPORATION\" aria-errormessage=\"wpforms-3282-field_12_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3282-field_12_1\">CORPORATION<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-3282-field_12_2\" name=\"wpforms[fields][12][]\" value=\"LLC\" aria-errormessage=\"wpforms-3282-field_12_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3282-field_12_2\">LLC<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-3282-field_12_3\" name=\"wpforms[fields][12][]\" value=\"PARTNERSHIP\" aria-errormessage=\"wpforms-3282-field_12_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3282-field_12_3\">PARTNERSHIP<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-3282-field_12_4\" name=\"wpforms[fields][12][]\" value=\"PROPRIETORSHIP\" aria-errormessage=\"wpforms-3282-field_12_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3282-field_12_4\">PROPRIETORSHIP<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-3282-field_12_5\" name=\"wpforms[fields][12][]\" value=\"OTHER\" aria-errormessage=\"wpforms-3282-field_12_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3282-field_12_5\">OTHER<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3282-field_91-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"91\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_91\">If Other<\/label><input type=\"text\" id=\"wpforms-3282-field_91\" class=\"wpforms-field-medium\" name=\"wpforms[fields][91]\" aria-errormessage=\"wpforms-3282-field_91-error\" ><\/div><div id=\"wpforms-3282-field_13-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_13\">FED TAX#<\/label><input type=\"text\" id=\"wpforms-3282-field_13\" class=\"wpforms-field-large\" name=\"wpforms[fields][13]\" aria-errormessage=\"wpforms-3282-field_13-error\" ><\/div><div id=\"wpforms-3282-field_92-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"92\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_92\">SS# <\/label><input type=\"text\" id=\"wpforms-3282-field_92\" class=\"wpforms-field-large\" name=\"wpforms[fields][92]\" aria-errormessage=\"wpforms-3282-field_92-error\" ><\/div><div id=\"wpforms-3282-field_93-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"93\"><div id=\"wpforms-3282-field_93\" aria-errormessage=\"wpforms-3282-field_93-error\"><h2>NUMBER OF\r\nEMPLOYEES<\/h2><\/div><\/div><div id=\"wpforms-3282-field_97-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"97\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_94-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"94\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_94\">OWNER\/PRESIDENT<\/label><input type=\"text\" id=\"wpforms-3282-field_94\" class=\"wpforms-field-large\" name=\"wpforms[fields][94]\" aria-errormessage=\"wpforms-3282-field_94-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_95-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"95\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_95\">PURCHASING AGENT<\/label><input type=\"text\" id=\"wpforms-3282-field_95\" class=\"wpforms-field-large\" name=\"wpforms[fields][95]\" aria-errormessage=\"wpforms-3282-field_95-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-3282-field_96-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"96\"><div id=\"wpforms-3282-field_96\" aria-errormessage=\"wpforms-3282-field_96-error\"><h2>IN BUSINESS\r\nSINCE\r\n<\/h2><\/div><\/div><div id=\"wpforms-3282-field_98-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"98\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_99-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"99\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_99\">ENGINEERING DEPT<\/label><input type=\"text\" id=\"wpforms-3282-field_99\" class=\"wpforms-field-large\" name=\"wpforms[fields][99]\" aria-errormessage=\"wpforms-3282-field_99-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_100-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"100\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_100\">MAINTENANCE DEPT<\/label><input type=\"text\" id=\"wpforms-3282-field_100\" class=\"wpforms-field-large\" name=\"wpforms[fields][100]\" aria-errormessage=\"wpforms-3282-field_100-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-3282-field_101-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"101\"><div id=\"wpforms-3282-field_101\" aria-errormessage=\"wpforms-3282-field_101-error\"><h2>LICENSING\r\nINFORMATION\r\n<\/h2><\/div><\/div><div id=\"wpforms-3282-field_102-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"102\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_103-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"103\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_103\">ELECTRICIANS LICENSE #<\/label><input type=\"text\" id=\"wpforms-3282-field_103\" class=\"wpforms-field-medium\" name=\"wpforms[fields][103]\" aria-errormessage=\"wpforms-3282-field_103-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_104-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"104\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_104\">NAME<\/label><input type=\"text\" id=\"wpforms-3282-field_104\" class=\"wpforms-field-medium\" name=\"wpforms[fields][104]\" aria-errormessage=\"wpforms-3282-field_104-error\" aria-describedby=\"wpforms-3282-field_104-description\" ><div id=\"wpforms-3282-field_104-description\" class=\"wpforms-field-description\">(MASTER OR CLASS B)\r\n<\/div><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-3282-field_105-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"105\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_106-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"106\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_106\">TYPE<\/label><input type=\"text\" id=\"wpforms-3282-field_106\" class=\"wpforms-field-medium\" name=\"wpforms[fields][106]\" aria-errormessage=\"wpforms-3282-field_106-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_107-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"107\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_107\">STATE<\/label><input type=\"text\" id=\"wpforms-3282-field_107\" class=\"wpforms-field-medium\" name=\"wpforms[fields][107]\" aria-errormessage=\"wpforms-3282-field_107-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-3282-field_108-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"108\"><div id=\"wpforms-3282-field_108\" aria-errormessage=\"wpforms-3282-field_108-error\"><h2>CREDIT REQUEST\r\n<\/h2><\/div><\/div><div id=\"wpforms-3282-field_109-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"109\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_110-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"110\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_110\">AMOUNT OF MONTHLY CREDIT REQUESTED<\/label><input type=\"text\" id=\"wpforms-3282-field_110\" class=\"wpforms-field-medium\" name=\"wpforms[fields][110]\" aria-errormessage=\"wpforms-3282-field_110-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_111-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"111\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_111\">ACCOUNTS PAYABLE CONTACT PERSON<\/label><input type=\"text\" id=\"wpforms-3282-field_111\" class=\"wpforms-field-medium\" name=\"wpforms[fields][111]\" aria-errormessage=\"wpforms-3282-field_111-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-3282-field_112-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"112\"><div id=\"wpforms-3282-field_112\" aria-errormessage=\"wpforms-3282-field_112-error\"><h2>TRADE\r\nREFERENCES\r\n\r\n<\/h2><\/div><\/div><div id=\"wpforms-3282-field_20-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"20\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-25-25\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-3282-field_21-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"21\"><div id=\"wpforms-3282-field_21\" aria-errormessage=\"wpforms-3282-field_21-error\"><b>FIRM NAME<\/b><\/div><\/div><div id=\"wpforms-3282-field_113-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"113\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3282-field_113\" aria-hidden=\"false\">Single Line Text<\/label><input type=\"text\" id=\"wpforms-3282-field_113\" class=\"wpforms-field-medium\" name=\"wpforms[fields][113]\" aria-errormessage=\"wpforms-3282-field_113-error\" ><\/div><div id=\"wpforms-3282-field_116-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"116\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3282-field_116\" aria-hidden=\"false\">Single Line Text (copy) (copy)<\/label><input type=\"text\" id=\"wpforms-3282-field_116\" class=\"wpforms-field-medium\" name=\"wpforms[fields][116]\" aria-errormessage=\"wpforms-3282-field_116-error\" ><\/div><div id=\"wpforms-3282-field_117-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"117\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3282-field_117\" aria-hidden=\"false\">Single Line Text (copy) (copy) (copy)<\/label><input type=\"text\" id=\"wpforms-3282-field_117\" class=\"wpforms-field-medium\" name=\"wpforms[fields][117]\" aria-errormessage=\"wpforms-3282-field_117-error\" ><\/div><div id=\"wpforms-3282-field_120-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"120\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3282-field_120\" aria-hidden=\"false\">Single Line Text (copy) (copy) (copy) (copy)<\/label><input type=\"text\" id=\"wpforms-3282-field_120\" class=\"wpforms-field-medium\" name=\"wpforms[fields][120]\" aria-errormessage=\"wpforms-3282-field_120-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-3282-field_22-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"22\"><div id=\"wpforms-3282-field_22\" aria-errormessage=\"wpforms-3282-field_22-error\"><b>ADDRESS<\/b><\/div><\/div><div id=\"wpforms-3282-field_26-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"26\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3282-field_26\" aria-hidden=\"false\">Single Line Text<\/label><input type=\"text\" id=\"wpforms-3282-field_26\" class=\"wpforms-field-medium\" name=\"wpforms[fields][26]\" aria-errormessage=\"wpforms-3282-field_26-error\" ><\/div><div id=\"wpforms-3282-field_30-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"30\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3282-field_30\" aria-hidden=\"false\">Single Line Text (copy)<\/label><input type=\"text\" id=\"wpforms-3282-field_30\" class=\"wpforms-field-medium\" name=\"wpforms[fields][30]\" aria-errormessage=\"wpforms-3282-field_30-error\" ><\/div><div id=\"wpforms-3282-field_34-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"34\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3282-field_34\" aria-hidden=\"false\">Single Line Text (copy) (copy)<\/label><input type=\"text\" id=\"wpforms-3282-field_34\" class=\"wpforms-field-medium\" name=\"wpforms[fields][34]\" aria-errormessage=\"wpforms-3282-field_34-error\" ><\/div><div id=\"wpforms-3282-field_121-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"121\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3282-field_121\" aria-hidden=\"false\">Single Line Text (copy) (copy) (copy)<\/label><input type=\"text\" id=\"wpforms-3282-field_121\" class=\"wpforms-field-medium\" name=\"wpforms[fields][121]\" aria-errormessage=\"wpforms-3282-field_121-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-3282-field_23-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"23\"><div id=\"wpforms-3282-field_23\" aria-errormessage=\"wpforms-3282-field_23-error\"><b>PHONE<\/b><\/div><\/div><div id=\"wpforms-3282-field_27-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"27\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3282-field_27\" aria-hidden=\"false\">Single Line Text (copy)<\/label><input type=\"text\" id=\"wpforms-3282-field_27\" class=\"wpforms-field-medium\" name=\"wpforms[fields][27]\" aria-errormessage=\"wpforms-3282-field_27-error\" ><\/div><div id=\"wpforms-3282-field_31-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"31\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3282-field_31\" aria-hidden=\"false\">Single Line Text (copy) (copy)<\/label><input type=\"text\" id=\"wpforms-3282-field_31\" class=\"wpforms-field-medium\" name=\"wpforms[fields][31]\" aria-errormessage=\"wpforms-3282-field_31-error\" ><\/div><div id=\"wpforms-3282-field_35-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"35\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3282-field_35\" aria-hidden=\"false\">Single Line Text (copy) (copy) (copy)<\/label><input type=\"text\" id=\"wpforms-3282-field_35\" class=\"wpforms-field-medium\" name=\"wpforms[fields][35]\" aria-errormessage=\"wpforms-3282-field_35-error\" ><\/div><div id=\"wpforms-3282-field_122-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"122\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3282-field_122\" aria-hidden=\"false\">Single Line Text (copy) (copy) (copy) (copy)<\/label><input type=\"text\" id=\"wpforms-3282-field_122\" class=\"wpforms-field-medium\" name=\"wpforms[fields][122]\" aria-errormessage=\"wpforms-3282-field_122-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-3282-field_114-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"114\"><div id=\"wpforms-3282-field_114\" aria-errormessage=\"wpforms-3282-field_114-error\"><b>EMAIL<\/b><\/div><\/div><div id=\"wpforms-3282-field_115-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"115\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3282-field_115\" aria-hidden=\"false\">Single Line Text (copy)<\/label><input type=\"text\" id=\"wpforms-3282-field_115\" class=\"wpforms-field-medium\" name=\"wpforms[fields][115]\" aria-errormessage=\"wpforms-3282-field_115-error\" ><\/div><div id=\"wpforms-3282-field_118-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"118\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3282-field_118\" aria-hidden=\"false\">Single Line Text (copy) (copy) (copy)<\/label><input type=\"text\" id=\"wpforms-3282-field_118\" class=\"wpforms-field-medium\" name=\"wpforms[fields][118]\" aria-errormessage=\"wpforms-3282-field_118-error\" ><\/div><div id=\"wpforms-3282-field_119-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"119\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3282-field_119\" aria-hidden=\"false\">Single Line Text (copy) (copy) (copy) (copy)<\/label><input type=\"text\" id=\"wpforms-3282-field_119\" class=\"wpforms-field-medium\" name=\"wpforms[fields][119]\" aria-errormessage=\"wpforms-3282-field_119-error\" ><\/div><div id=\"wpforms-3282-field_123-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"123\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3282-field_123\" aria-hidden=\"false\">Single Line Text (copy) (copy) (copy) (copy) (copy)<\/label><input type=\"text\" id=\"wpforms-3282-field_123\" class=\"wpforms-field-medium\" name=\"wpforms[fields][123]\" aria-errormessage=\"wpforms-3282-field_123-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-3282-field_24-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"24\"><div id=\"wpforms-3282-field_24\" aria-errormessage=\"wpforms-3282-field_24-error\"><h2>BANK\r\nREFERENCE<\/h2><\/div><\/div><div id=\"wpforms-3282-field_124-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"124\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-3282-field_28-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_28\">BANK<\/label><input type=\"text\" id=\"wpforms-3282-field_28\" class=\"wpforms-field-medium\" name=\"wpforms[fields][28]\" aria-errormessage=\"wpforms-3282-field_28-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-3282-field_32-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"32\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_32\">CITY<\/label><input type=\"text\" id=\"wpforms-3282-field_32\" class=\"wpforms-field-medium\" name=\"wpforms[fields][32]\" aria-errormessage=\"wpforms-3282-field_32-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-3282-field_36-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_36\">STATE<\/label><input type=\"text\" id=\"wpforms-3282-field_36\" class=\"wpforms-field-medium\" name=\"wpforms[fields][36]\" aria-errormessage=\"wpforms-3282-field_36-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-3282-field_125-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"125\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_126-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"126\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_126\">CONTACT PERSON<\/label><input type=\"text\" id=\"wpforms-3282-field_126\" class=\"wpforms-field-medium\" name=\"wpforms[fields][126]\" aria-errormessage=\"wpforms-3282-field_126-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_130-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"130\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_130\">CHECKING PERSON ACCT#<\/label><input type=\"text\" id=\"wpforms-3282-field_130\" class=\"wpforms-field-medium\" name=\"wpforms[fields][130]\" aria-errormessage=\"wpforms-3282-field_130-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-3282-field_128-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"128\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_129-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"129\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_129\">PHONE #<\/label><input type=\"text\" id=\"wpforms-3282-field_129\" class=\"wpforms-field-medium\" name=\"wpforms[fields][129]\" aria-errormessage=\"wpforms-3282-field_129-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_127-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"127\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_127\">ROUTING NUMBER<\/label><input type=\"text\" id=\"wpforms-3282-field_127\" class=\"wpforms-field-medium\" name=\"wpforms[fields][127]\" aria-errormessage=\"wpforms-3282-field_127-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-3282-field_37-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"37\"><div id=\"wpforms-3282-field_37\" aria-errormessage=\"wpforms-3282-field_37-error\"><h2>SALES TAX\r\n<\/h2><\/div><\/div><div id=\"wpforms-3282-field_38-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"38\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-33-67\"><div class=\"wpforms-layout-column wpforms-layout-column-33\" ><div id=\"wpforms-3282-field_39-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-id=\"39\"><fieldset><legend class=\"wpforms-field-label\">SALES TAX TO BE CHARGED?<\/legend><ul id=\"wpforms-3282-field_39\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3282-field_39_1\" name=\"wpforms[fields][39][]\" value=\"YES\" aria-errormessage=\"wpforms-3282-field_39_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3282-field_39_1\">YES<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-3282-field_39_2\" name=\"wpforms[fields][39][]\" value=\"NO\" aria-errormessage=\"wpforms-3282-field_39_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3282-field_39_2\">NO<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-67\" ><div id=\"wpforms-3282-field_40-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"40\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_40\">IF \u201cNO,\u201d PLEASE COMPLETE AND SIGN A SALES TAX EXEMPTION CERTIFICATE AND RETURN WITH THIS APPLICATION.<\/label><input type=\"text\" id=\"wpforms-3282-field_40\" class=\"wpforms-field-medium\" name=\"wpforms[fields][40]\" aria-errormessage=\"wpforms-3282-field_40-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-3282-field_54-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"54\"><div id=\"wpforms-3282-field_54\" aria-errormessage=\"wpforms-3282-field_54-error\"><h2>OFFICE USE <\/h2><\/div><\/div><div id=\"wpforms-3282-field_56-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"56\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-3282-field_57-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"57\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_57\">BRANCH#<\/label><input type=\"text\" id=\"wpforms-3282-field_57\" class=\"wpforms-field-medium\" name=\"wpforms[fields][57]\" aria-errormessage=\"wpforms-3282-field_57-error\" ><\/div><div id=\"wpforms-3282-field_132-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"132\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_132\">CUSTOMER GROUP<\/label><input type=\"text\" id=\"wpforms-3282-field_132\" class=\"wpforms-field-medium\" name=\"wpforms[fields][132]\" aria-errormessage=\"wpforms-3282-field_132-error\" ><\/div><div id=\"wpforms-3282-field_134-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"134\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_134\">SR<\/label><input type=\"text\" id=\"wpforms-3282-field_134\" class=\"wpforms-field-medium\" name=\"wpforms[fields][134]\" aria-errormessage=\"wpforms-3282-field_134-error\" ><\/div><div id=\"wpforms-3282-field_136-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"136\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_136\">APPROVAL BR MGR <\/label><input type=\"text\" id=\"wpforms-3282-field_136\" class=\"wpforms-field-medium\" name=\"wpforms[fields][136]\" aria-errormessage=\"wpforms-3282-field_136-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-3282-field_131-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"131\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_131\">SALES TERRITORY<\/label><input type=\"text\" id=\"wpforms-3282-field_131\" class=\"wpforms-field-medium\" name=\"wpforms[fields][131]\" aria-errormessage=\"wpforms-3282-field_131-error\" ><\/div><div id=\"wpforms-3282-field_133-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"133\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_133\">PRICE LEVEL<\/label><input type=\"text\" id=\"wpforms-3282-field_133\" class=\"wpforms-field-medium\" name=\"wpforms[fields][133]\" aria-errormessage=\"wpforms-3282-field_133-error\" ><\/div><div id=\"wpforms-3282-field_135-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"135\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_135\">TRANS ZONE<\/label><input type=\"text\" id=\"wpforms-3282-field_135\" class=\"wpforms-field-medium\" name=\"wpforms[fields][135]\" aria-errormessage=\"wpforms-3282-field_135-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-3282-field_137-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"137\"><fieldset><legend class=\"wpforms-field-label\">ARE YOU SUBJECT TO A CITY OR COUNTY TAX?<\/legend><ul id=\"wpforms-3282-field_137\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3282-field_137_1\" name=\"wpforms[fields][137][]\" value=\"YES\" aria-errormessage=\"wpforms-3282-field_137_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3282-field_137_1\">YES<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-3282-field_137_2\" name=\"wpforms[fields][137][]\" value=\"NO\" aria-errormessage=\"wpforms-3282-field_137_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3282-field_137_2\">NO<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3282-field_138-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"138\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_138\">ARE YOU SUBJECT TO A CITY OR COUNTY TAX?<\/label><input type=\"text\" id=\"wpforms-3282-field_138\" class=\"wpforms-field-medium\" name=\"wpforms[fields][138]\" aria-errormessage=\"wpforms-3282-field_138-error\" ><\/div><div id=\"wpforms-3282-field_80-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"80\"><div id=\"wpforms-3282-field_80\" aria-errormessage=\"wpforms-3282-field_80-error\"><h2>Invoices are emailed.<\/h2><\/div><\/div><div id=\"wpforms-3282-field_139-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"139\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_139\">Please provide the email address of your Accounts Payable department: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-3282-field_139\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][139]\" spellcheck=\"false\" aria-errormessage=\"wpforms-3282-field_139-error\" required><\/div><div id=\"wpforms-3282-field_140-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"140\"><div id=\"wpforms-3282-field_140\" aria-errormessage=\"wpforms-3282-field_140-error\"><h2>TERMS AND CONDITIONS OF CREDIT<\/h2><\/div><\/div><div id=\"wpforms-3282-field_82-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"82\"><div id=\"wpforms-3282-field_82\" aria-errormessage=\"wpforms-3282-field_82-error\">In consideration for Border States Industries, Inc., dba Border States, Border States Electric and Chapman Metering, (\u201cCompany\u201d) permitting the undersigned individual or entity (\u201cApplicant\u201d) 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:<\/div><\/div><div id=\"wpforms-3282-field_141-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"141\"><div id=\"wpforms-3282-field_141\" aria-errormessage=\"wpforms-3282-field_141-error\">1 . The person(s) signing this credit application (\u201cApplication\u201d) 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.<\/div><\/div><div id=\"wpforms-3282-field_142-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"142\"><div id=\"wpforms-3282-field_142\" aria-errormessage=\"wpforms-3282-field_142-error\">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.<\/div><\/div><div id=\"wpforms-3282-field_143-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"143\"><div id=\"wpforms-3282-field_143\" aria-errormessage=\"wpforms-3282-field_143-error\">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.<\/div><\/div><div id=\"wpforms-3282-field_144-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"144\"><div id=\"wpforms-3282-field_144\" aria-errormessage=\"wpforms-3282-field_144-error\">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.\r\nThe law of the state where the Company\u2019s 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\u2019s 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.<\/div><\/div><div id=\"wpforms-3282-field_145-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"145\"><div id=\"wpforms-3282-field_145\" aria-errormessage=\"wpforms-3282-field_145-error\">5. Company's Terms and Conditions of Sale apply to all transactions between Company and Applicant and are incorporated herein by reference. These\r\nterms are located at www.borderstates.com and may be updated as necessary by Company. No terms or conditions or purchase orders of the Applicant\r\nthat are different from the Company terms will become part of any contract unless approved in writing and signed by an Officer of the Company.<\/div><\/div><div id=\"wpforms-3282-field_146-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"146\"><div id=\"wpforms-3282-field_146\" aria-errormessage=\"wpforms-3282-field_146-error\">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\u2019s security interest. Company retains all rights, as appropriate and necessary, to file mechanics liens, bond rights and file lawsuit for payment.<\/div><\/div><div id=\"wpforms-3282-field_147-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"147\"><div id=\"wpforms-3282-field_147\" aria-errormessage=\"wpforms-3282-field_147-error\">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\u2019s account) as the Company shall request from time to time. In addition, the Company is authorized to obtain, from time\r\nto time, credit reports on the Applicant. The undersigned hereby consent(s) to the Company\u2019s 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\r\nundersigned 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. \u00b6 1681 et. seq.<\/div><\/div><div id=\"wpforms-3282-field_148-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"148\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_149-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"149\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_149\">Name Printed<\/label><input type=\"text\" id=\"wpforms-3282-field_149\" class=\"wpforms-field-medium\" name=\"wpforms[fields][149]\" aria-errormessage=\"wpforms-3282-field_149-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_151-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"151\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_151\">Name Printed<\/label><input type=\"text\" id=\"wpforms-3282-field_151\" class=\"wpforms-field-medium\" name=\"wpforms[fields][151]\" aria-errormessage=\"wpforms-3282-field_151-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_83-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"83\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_83\">Signature<\/label><input type=\"text\" id=\"wpforms-3282-field_83\" class=\"wpforms-signature-input wpforms-screen-reader-element\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][83]\" autocomplete=\"off\" inputmode=\"none\" aria-errormessage=\"wpforms-3282-field_83-error\" ><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-3282-field_83-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Borrar firma\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Borrar firma<\/div>\n\t\t\t<\/div><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_152-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"152\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_152\">Signature<\/label><input type=\"text\" id=\"wpforms-3282-field_152\" class=\"wpforms-signature-input wpforms-screen-reader-element\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][152]\" autocomplete=\"off\" inputmode=\"none\" aria-errormessage=\"wpforms-3282-field_152-error\" ><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-3282-field_152-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Borrar firma\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Borrar firma<\/div>\n\t\t\t<\/div><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_150-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"150\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_150\">Social Security Number<\/label><input type=\"number\" id=\"wpforms-3282-field_150\" class=\"wpforms-field-medium\" name=\"wpforms[fields][150]\" step=\"any\" aria-errormessage=\"wpforms-3282-field_150-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_153-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"153\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_153\">Social Security Number<\/label><input type=\"number\" id=\"wpforms-3282-field_153\" class=\"wpforms-field-medium\" name=\"wpforms[fields][153]\" step=\"any\" aria-errormessage=\"wpforms-3282-field_153-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-3282-field_154-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"154\"><div id=\"wpforms-3282-field_154\" aria-errormessage=\"wpforms-3282-field_154-error\">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.<\/div><\/div><div id=\"wpforms-3282-field_156-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"156\"><div id=\"wpforms-3282-field_156\" aria-errormessage=\"wpforms-3282-field_156-error\">By signing below, the Applicant acknowledges its agreement to these Terms and Conditions of Credit, and the individual signing on behalf of the Applicant\r\nwarrants that they are signing with full and complete authority to bind Applicant.<\/div><\/div><div id=\"wpforms-3282-field_158-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"158\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_158\">Name of company or entity<\/label><input type=\"text\" id=\"wpforms-3282-field_158\" class=\"wpforms-field-large\" name=\"wpforms[fields][158]\" aria-errormessage=\"wpforms-3282-field_158-error\" ><\/div><div id=\"wpforms-3282-field_157-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"157\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_159-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"159\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_159\">Signed by:<\/label><input type=\"text\" id=\"wpforms-3282-field_159\" class=\"wpforms-field-medium\" name=\"wpforms[fields][159]\" aria-errormessage=\"wpforms-3282-field_159-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_160-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"160\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_160\">Title:<\/label><input type=\"text\" id=\"wpforms-3282-field_160\" class=\"wpforms-field-medium\" name=\"wpforms[fields][160]\" aria-errormessage=\"wpforms-3282-field_160-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_161-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"161\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_161\">Name Printed:<\/label><input type=\"text\" id=\"wpforms-3282-field_161\" class=\"wpforms-field-medium\" name=\"wpforms[fields][161]\" aria-errormessage=\"wpforms-3282-field_161-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_162-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"162\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_162\">Date:<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-3282-field_162\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][162][date]\" aria-errormessage=\"wpforms-3282-field_162-error\" ><a title=\"Borrar fecha\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Borrar fecha\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-3282-field_163-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"163\"><div id=\"wpforms-3282-field_163\" aria-errormessage=\"wpforms-3282-field_163-error\"><h2>PERSONAL GUARANTEE<\/h2><\/div><\/div><div id=\"wpforms-3282-field_165-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"165\"><div id=\"wpforms-3282-field_165\" aria-errormessage=\"wpforms-3282-field_165-error\">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\r\nApplicant, which have in the past or may in the future be owing the Company on open account or otherwise under the same conditions.\r\nThe obligations under this guarantee are primary and independent of the Applicant\u2019s obligations, and the undersigned waive: (1) any\r\nright to require the Company to proceed against Applicant or pursue any other remedy and any statute of limitations pertaining thereto;\r\n(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\u2019s present or future indebtedness to the Company.<\/div><\/div><div id=\"wpforms-3282-field_166-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"166\"><div id=\"wpforms-3282-field_166\" aria-errormessage=\"wpforms-3282-field_166-error\">The undersigned hereby consent(s) to the Company\u2019s use of a non-business consumer credit report on the undersigned in order to\r\nfurther evaluate the credit worthiness of the undersigned as principal(s), proprietor(s) and\/or guarantee(s) in connection with the\r\nextension of business credit as contemplated by this Application. The undersigned hereby authorizes the Company to utilize a consumer\r\ncredit report on the undersigned from time to time in connection with the extension or continuation of the business credit represented\r\nby this Application. The undersigned as (an) individual(s) hereby knowingly consent(s) to the use of such credit report consistent with\r\nthe Federal Fair Credit Reporting Act as contained in 15 U.S.C. \u00b6 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,\r\nMaryland, 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. <\/div><\/div><div id=\"wpforms-3282-field_167-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"167\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_175-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"175\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_175\">Dated this<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-3282-field_175\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][175][date]\" aria-errormessage=\"wpforms-3282-field_175-error\" ><a title=\"Borrar fecha\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Borrar fecha\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_174-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"174\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_174\">day of<\/label><input type=\"text\" id=\"wpforms-3282-field_174\" class=\"wpforms-field-medium\" name=\"wpforms[fields][174]\" aria-errormessage=\"wpforms-3282-field_174-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_170-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"170\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_170\">Name Printed:<\/label><input type=\"text\" id=\"wpforms-3282-field_170\" class=\"wpforms-field-medium\" name=\"wpforms[fields][170]\" aria-errormessage=\"wpforms-3282-field_170-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_171-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"171\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_171\">Social Security Number:<\/label><input type=\"text\" id=\"wpforms-3282-field_171\" class=\"wpforms-field-medium\" name=\"wpforms[fields][171]\" aria-errormessage=\"wpforms-3282-field_171-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_172-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"172\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_172\">Signed:<\/label><input type=\"text\" id=\"wpforms-3282-field_172\" class=\"wpforms-signature-input wpforms-screen-reader-element\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][172]\" autocomplete=\"off\" inputmode=\"none\" aria-errormessage=\"wpforms-3282-field_172-error\" ><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-3282-field_172-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Borrar firma\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Borrar firma<\/div>\n\t\t\t<\/div><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_176-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"176\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_176\">Address:<\/label><textarea id=\"wpforms-3282-field_176\" class=\"wpforms-field-medium\" name=\"wpforms[fields][176]\" aria-errormessage=\"wpforms-3282-field_176-error\" ><\/textarea><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-3282-field_177-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"177\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_179-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"179\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_179\">Name Printed:<\/label><input type=\"text\" id=\"wpforms-3282-field_179\" class=\"wpforms-field-medium\" name=\"wpforms[fields][179]\" aria-errormessage=\"wpforms-3282-field_179-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_182-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"182\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_182\">Social Security Number: <\/label><input type=\"text\" id=\"wpforms-3282-field_182\" class=\"wpforms-field-medium\" name=\"wpforms[fields][182]\" aria-errormessage=\"wpforms-3282-field_182-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_180-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"180\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_180\">Signed:<\/label><input type=\"text\" id=\"wpforms-3282-field_180\" class=\"wpforms-signature-input wpforms-screen-reader-element\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][180]\" autocomplete=\"off\" inputmode=\"none\" aria-errormessage=\"wpforms-3282-field_180-error\" ><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-3282-field_180-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Borrar firma\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Borrar firma<\/div>\n\t\t\t<\/div><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-3282-field_183-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"183\"><label class=\"wpforms-field-label\" for=\"wpforms-3282-field_183\">Address:<\/label><textarea id=\"wpforms-3282-field_183\" class=\"wpforms-field-medium\" name=\"wpforms[fields][183]\" aria-errormessage=\"wpforms-3282-field_183-error\" ><\/textarea><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-3282-field_184-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"184\"><div id=\"wpforms-3282-field_184\" aria-errormessage=\"wpforms-3282-field_184-error\">GUARANTOR MAY REVOKE THIS GUARANTEE AS TO FUTURE TRANSACTIONS ONLY BY SERVING WRITTEN\r\nNOTICE UPON THE COMPANY, BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED, AT THE ADDRESS THAT THE\r\nACCOUNT IS MANAGED. RECEIPT OF SUCH NOTIFICATION WILL NOT RELIEVE GUARANTOR OF ITS GUARANTEE\r\nLIABILITY BY THE COMPANY FOR ANY ORDERS ACCEPTED BY THE COMPANY ON OR BEFORE THE DAY THE\r\nCOMPANY RECEIVES SAID REVOCATION.<\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-hcaptcha\" ><div class=\"h-captcha\" data-sitekey=\"c228c6f2-3aa8-4ebc-9ca8-da5c78a8a3b0\"><\/div><input type=\"text\" name=\"g-recaptcha-hidden\" class=\"wpforms-recaptcha-hidden\" style=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\" data-rule-hcaptcha=\"1\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"3282\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/dominionelectric.com\/es\/wp-json\/wp\/v2\/pages\/3286\"><input type=\"hidden\" name=\"url_referer\" value=\"\">\t\t<div id=\"cf-turnstile-wpf-2551195995\"\r\n\t\tclass=\"cf-turnstile\" \t\tdata-sitekey=\"0x4AAAAAACsP_5CKbDqKdWr2\"\r\n\t\tdata-theme=\"light\"\r\n\t\tdata-language=\"auto\"\r\n\t\tdata-size=\"normal\"\r\n\t\tdata-retry=\"auto\" data-retry-interval=\"1000\"\r\n\t\tdata-refresh-expired=\"auto\"\r\n\t\tdata-action=\"wpforms-3282\"\r\n\t\t\t\tdata-appearance=\"always\"><\/div>\r\n\t\t\t<script>document.addEventListener(\"DOMContentLoaded\", function() { setTimeout(function(){ var e=document.getElementById(\"cf-turnstile-wpf-2551195995\"); e&&!e.innerHTML.trim()&&(turnstile.remove(\"#cf-turnstile-wpf-2551195995\"), turnstile.render(\"#cf-turnstile-wpf-2551195995\", {sitekey:\"0x4AAAAAACsP_5CKbDqKdWr2\"})); }, 100); });<\/script>\r\n\t\t\t<br class=\"cf-turnstile-br cf-turnstile-br-wpf-2551195995\">\r\n\t\t\t\t<style>#cf-turnstile-wpf-2551195995 { margin-left: -15px; }<\/style>\r\n\t\t<button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-3282\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" src=\"https:\/\/dominionelectric.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Cargando\" title=\"\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>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 1CitySTATEAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip Code [&hellip;]<\/p>\n","protected":false},"author":23,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-3286","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/dominionelectric.com\/es\/wp-json\/wp\/v2\/pages\/3286","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dominionelectric.com\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dominionelectric.com\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dominionelectric.com\/es\/wp-json\/wp\/v2\/users\/23"}],"replies":[{"embeddable":true,"href":"https:\/\/dominionelectric.com\/es\/wp-json\/wp\/v2\/comments?post=3286"}],"version-history":[{"count":0,"href":"https:\/\/dominionelectric.com\/es\/wp-json\/wp\/v2\/pages\/3286\/revisions"}],"wp:attachment":[{"href":"https:\/\/dominionelectric.com\/es\/wp-json\/wp\/v2\/media?parent=3286"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}