Online Credit Application

Please complete all fields and submit your online credit application form.

Our credit application is also available in adobe pdf format if you prefer
to print it out and fax it to us (fax number included on form).

_______________________________________________________________________________________________________

Company Name:
Mailing Address:
City/State/Zip:
Street Address:
City/State/Zip:
Year Established:
Telephone Number:
Fax Number:
Resale Number:
____________________________________________________________________
Name of Principal:
President/Owner:
Business Type:
Credit Line Requested:
Estimated Annual Purchases:
____________________________________________________________________
Credit References:
Name of Bank:
Address:
City/State/Zip:
Account Number:
Telephone Number:
Fax Number:
____________________________________________________________________
Trade Reference 1:
Company:
Address:
City/State/Zip:
Telephone Number:
____________________________________________________________________
Trade References 2:
Company:
Address:
City/State/Zip:
Telephone Number:
____________________________________________________________________
Trade References 3:
Company:
Address:
City/State/Zip:
Telephone Number:
____________________________________________________________________
I hereby authorize the disclosure of information as requested by Brilliant Lighting to process this credit application.
Company Name:
Authorized Personal:
Title:
Date:
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