LEDTRONICS CREDIT VERIFICATION FORM


There are two ways to submit this form; either by submitting online the form below, or printing out the blank form, filling it out, and faxing to (310) 534-1424. The fields marked with a red asterisk (*) are required. Security is a top priority at LEDtronics.com. Any sensitive information submitted to LEDtronics is encrypted and protected with the most advanced form of SSL software available: 256-bit encryption.

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

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

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

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


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


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