CARDELLO

ELECTRIC SUPPLY COMPANY

GENERAL INFORMATION
Full Company Name
Address                    
                                  
City                           
State                         
Zip                             
Date                          
Business Phone        
Fax Number              
Email                         
Years in Business     
Type of Business      
         Own Rent Your Place of Business
____________________________________________________________
BILLING ADDRESS  
If Billing Address is the same, please leave blank
Billing Address   
                             
Billing City          
Billing State        
Billing Zip           
Attn:                    
                            
A/P Contact        
A/P Email           
Please check below your preferred method to receive your invoices and statements.
Name:      
Company:
Title         
Phone #    Ext.  
I Prefer U.S.Mail Email Fax
Indicate the email address or fax number if either of those options was selected:
____________________________________________________________
ADVERTISING
For advertising purposes what is your mailing address and to whom should it be directed to
(i.e. name of person, purchasing agent or dept.) If the address is the same as above please leave blank
and only fill in the name of person to whom it should be directed to.
Adv. Address  
                         
Adv. City         
Adv. State       
Adv. Zip           
Adv. Attn:        
                         
Adv. Contact   
Adv. Email      
____________________________________________________________
TAXABLE STATUS
If your purchases are exempt from PA State Sales Tax, please provide your exemption number on the line below.
(You must also attach a valid exemption certificate and mail it in with this form.)
Exemption Number  
____________________________________________________________
REFERENCES
Please list at least (3) suppliers with whom you have active open accounts
Name of Company
                               
Address                 
                               
Phone Number       Ext.  
Fax Number          
Email                     

Name of Company
                               
Address                 
                               
Phone Number       Ext.  
Fax Number          
Email                     

Name of Company
                               
Address                 
                               
Phone Number       Ext.  
Fax Number          
Email                     

____________________________________________________________
Name of Your Bank
Account Number     
Bank Contact          
Phone Number         Ext.  
____________________________________________________________
Is Your Company a:
* Sole Proprietorship (list owner's name)
Owner's Name      
Address                 
                               
Phone Number       Ext.  
Fax Number          
Email                     

* Partnership (list partners's names)
Partner's Name     
Address                 
                               
Phone Number       Ext.  
Fax Number          
Email                     

Partner's Name     
Address                 
                               
Phone Number       Ext.  
Fax Number          
Email                     

* Corporation (list officers's names)
Officer's Name     
Address                 
                               
Phone Number       Ext.  
Fax Number          
Email                     

Officer's Name     
Address                 
                               
Phone Number       Ext.  
Fax Number          
Email                     

Officer's Name     
Address                 
                               
Phone Number       Ext.  
Fax Number          
Email                     

Officer's Name     
Address                 
                               
Phone Number       Ext.  
Fax Number          
Email                     

____________________________________________________________
APPLICATION FOR OPEN ACCOUNT
AGREEMENT
Applicant hereby agrees to pay any current upaid balance of the OPEN ACCOUNT on demand.
In the event that the unpaid balance is not paid with the payment terms of the invoice,
applicant hereby agrees to pay a delinquency charge on the unpaid balance of said invoice
at the rate of 1.5 % per month (18% per annum), with a minimum charge of $ 1.00 per month.

Applicant hereby agrees and acknowledges that the said delinquency charge shall also be applied
to any delinquency charge previously due and not paid by applicant; that said application shall
have a compounding effect on delinquency charges due and not paid; and the applicant agrees to pay same.

Applicant hereby acknowledges that any purchases made hereunder are solely for commercial or
business purposes, are not secured by any household goods or furnishings, and are hereby
specifically exempted from the provisions of the Consumer Credit Protection Act (15 U.S.C.A. 1603)
and the regulations promulgated thereunder and the provisions of the Ohio Usury Law
(OHIO REV. CODE ANN. Par. 1343.01 (B) (5)).

If any amount due is not paid and must be placed into the hands of a collector or attorney, then
additional charges will be due for the cost of collection, interest costs, reasonable
attorney's fees, and legal apperances in court for professional testimony.

APPLICANT
Name (please print clearly)

Title

Company

Signature

Date

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