LiveWire Electrical Supply Inc. - NEW AND USED ELECTRICAL PRODUCTS

Online Form Printable Credit Application

* indicates required field

Official Business Name*
Type of Company*		Proprietorship Partnership Corporation
If other Proprietorship or Corporation: Provide
Majority Owner Name*:
Majority Owner Address*:
Majority Owner Home Phone*:
Majority Owner Social Security Number*:
Name*:
Address*:
Remit to Address*:
Physical Business Address*:
Contact Phone*:
Contact Fax*:
D&B Number: (if applicable)
Annual Sales:
Number of Employees:
If For Resale
Federal Tax ID Number:
CA Reseller Cert Number: (if applicable)
Accounts Payable Contact Information
Accounts Payable Contact Name
Accounts Payable Contact E-Mail:
Preferred Method of Receiving Invoices:		E-Mail Fax Mail
3 Professional Credit References

Company Name (1)*:
Accounts Payable Contact*:
Fax Number*:
Phone Number*:
Remit To Address*:

Company Name(2)*:
Accounts Payable Contact*:
Fax Number*:
Phone Number*:
Remit To Address*:

Company Name (3) *:
Accounts Payable Contact*:
Fax Number*:
Phone Number*:
Remit To Address*:

Banking Reference
Bank Account Information (For Records Only)*:
Bank Name and Branch location*:
Checking Account Number*:
Additional Bank Account Information (For Records Only):
Bank Name and Branch location:
Checking Account Number:
Credit Line Requested
Amount of Credit Requested:
I have read the warranty and credit terms and conditions and I am authorized to request credit on behalf of the company I represent.*
All Information provided herein is complete and true. Signer has authority to allow LiveWire Electrical Supply Inc. to contact listed references to obtain company’s credit information. It is agreed and understood that third party collection agencies may be contracted in the event of a default. Signer acknowledges and agrees on behalf of company to pay any and all fees associated with third party collections, further, owners of proprietorships and partnerships can be held personally responsible for defaulted payments. No discounts can be applied to accounts without written consent from LiveWire Supply. Late payments may be subject to interest charges of no less than 18% (per annum maximum). All accounts should be paid according to the accounting terms provided to you by LiveWire Electrical Supply Inc." Sales Terms and Conditions and Warranty Returns: A return authorization must be obtained from the LiveWire Online Customer Service Center or from a member of the LiveWire Electrical Supply Inc. sales team or management group. Visit www.livewiresupply.com/customersupport to apply for a return authorization number. Restocking fees may be assessed to all returns not qualifying for a refund and when a customer does not request a replacement. While the specific restocking fee is left to the seller's discretion, all items returned are subject to a restocking fee of up to 100%. Shipper is not responsible for equipment damaged in transit. Refunds: LiveWire Electrical Supply Inc. will issue refunds (less restocking fees as determined appropriate by the LiveWire Electrical Supply sales team or management group) in the form of original payment for items that meet return requirements and are post marked no later than 30 days from purchase date. Refunds will be issued within 30 days of receipt of properly returned items. Items damaged or lost in shipment to or from LiveWire Electrical Supply Inc. will not be refunded. Returns postmarked later than 30 days and not later than 1 year from the original date of purchase are eligible for replacement in accordance with LiveWire Electrical Supply Inc.'s warranty policies. Seller’s Limited Liability: By agreeing to these terms and conditions they buyer acknowledges that LiveWire Supply is not liable for indirect, special, incidental, consequential or punitive damage. Further, LiveWire Supply shall not be required to pay transportation charges unless those charges are agreed upon in writing. Amendments may be accepted, but must be signed or otherwise mutually agreed upon prior to initiation of the sales agreement. Buyer agrees not to file suit against LiveWire Supply more than one (1) year from the date the cause of action accrues or outside of a product’s warranty