Terms Application

Business Information:
If checking, please upload tax exemption certificate.
Trade Credit References:
Bank Information: We will contact you for account number(s)

The undersigned acknowledges that he/she is a purchaser of materials from Emergency Lite Service Center, Inc. (ELSC, INC.) and intends to continue to make intermittent purchases. In consideration of the continuance of business as foresaid, the undersigned agrees that in the event that the nature of the business entity now engaging in such purchases should change in any way, the undersigned shall immediately notify Emergency Lite Service Center, Inc. of the fact and of all particulars relating thereto.

In the event that the undersigned shall fail to comply with this requirement, it is agreed that both the present business entity and all successor business entities shall be responsible for all the amounts due and owing for all purchases whenever made by each and every such business entity.

(I/We) understand that payments on account must be made according to terms indicated on invoices. It is further understood that a service charge of 1.5% (18% per annum), but not to exceed the maximum legal rate, will be assessed on the past due portion of the account and that reasonable collection costs and attorney fees will be the responsibility of the Buyer & Their Respected Company/ies as well as collection efforts if necessary.

**Customer Credit Card, must be placed on file with ELSC, INC. if the "YES" box is checked. This is to Ensure Payment is Secured, and after 30 Days Past due ( 60 Days Total from ship date ) the Credit Card on File will be charged the Balance on the Acct that is Past Due Plus the applicable Processing Fees.

If this box is checked, Credit Card Required to be Retained on File | 30 day Past Due will be Charged + Applicable Fees.
We will contact you for card number
Person Completing this form: