Electric Supply Credit Application

Electric Supply Company of North Carolina

Credit Terms: All bills are due and payable on or before the 25th of the month following date of purchase. A finance charge of 1.5% per month will be assessed on past due accounts. By submitting this application, you indicate that you understand our terms and agree to abide by them.

Thank you for applying for credit with Electric Supply Company

(*) denotes a required field

Electric Supply Co. location where you order your supplies:
*Company's Full Legal Name:
*Billing Address:
*City:
*State:
*Zip Code:
*Phone:
Fax:
*Name of Authorized Representative:
*Email address of Authorized Representative:
*Title of Representative:
*Credit Amount Requested:
If you currently have an account with us and are requesting an adjustment to your credit limit, please check this block.		Request for Credit Limit Adjustment
*Type of Organization:
Org.Type if "Other":
*Year Business Started:
DUNS Number:
*Billing Contact:

Please list (4) trade references:
Reference 1
*Company Name:
*Address:
*City:
*State:
*Zip:
*Phone:
Fax:

Reference 2
*Company Name:
*Address:
*City:
*State:
*Zip:
*Phone:
Fax:

Reference 3
*Company Name:
*Address:
*City:
*State:
*Zip:
*Phone:
Fax:

Reference 4
Company Name:
Address:
City:
State:
Zip:
Phone:
Fax:

By clicking the "Submit" button, you are agreeing to the credit terms for Electric Supply Company as outlined at the top of this page.

Electric Supply Company
Headquarters
714 West Johnson St.
Raleigh, NC 27603
(919) 828-3726