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Industry trade professionals are invited to apply for an Atom Lighting Trade Account. Once approved your company will qualify for customized pricing, bulk product rates, annual rebate offers up to 20% and other factory purchase incentives. Please complete the following form in it's entirety. Required fields are indicated with a red asterick (*).

General Information:

Business Name:	*		Business Phone:	*
Primary Contact:	*		Business Fax:	*
Contact Email:	*		Business Cell:
Business Website:
		Physical Address same as Billing Address
Billing Address 1:	*		Physical Address 1:	*
Billing Address 2:			Physical Address 2:
City:	*		City:	*
State:	*		State:	*
Zip Code:	*		Zip Code:	*
Country:	*		Country:	*

Business Trade Type:	*
Industry Affiliations:
Years in Business:	*
Number of Employees:	*
State Work Within:
Region Work Within:

Sales Tax: *	Charge Sales Tax No Sales Tax Required (Please email or fax resale exempt certificate)

Business Type: *	Proprietorship Partnership Corporation Limited Liability Corporation

Proprietorship Information:

Proprietor Name:	*	Address 1:	*
DBA:	*	Address 2:
Social Security #:	*	City:	*
Drivers License #:	*	State:	*
Drivers License State:	*	Zip Code:	*
		Country:	*

Partnership Information:

Date of Partnership:	*
Fed ID#:	*
DUNS#:	*

Partner #1 Name:	*	Partner #2 Name:
Percentage Ownership:	*	Percentage Ownership:
Address 1:	*	Address 1:
Address 2:		Address 2:
City:	*	City:
State:	*	State:
Zip Code:	*	Zip Code:
Country:	*	Country:
Social Security #:	*	Social Security #:
Drivers License #:	*	Drivers License #:
Drivers License State:	*	Drivers License State:

Corporation Information:

Date of Corporation:	*
Fed ID#:	*
DUNS#:	*

President:	*	Vice-President:	*
Address 1:	*	Address 1:	*
Address 2:		Address 2:
City:	*	City:
State:	*	State:
Zip Code:	*	Zip Code:
Country:	*	Country:
Social Security #:	*	Social Security #:
Drivers License #:	*	Drivers License #:
Drivers License State:	*	Drivers License State:

Secretary:	*	Treasurer:	*
Address 1:		Address 1:
Address 2:		Address 2:
City:		City:
State:		State:
Zip Code:		Zip Code:
Country:		Country:
Social Security #:		Social Security #:
Drivers License #:		Drivers License #:
Drivers License State:		Drivers License State:

Limited Liability Corporation Information:

Date of Corporation:	*
Fed ID#:	*
DUNS#:	*

General Partner:	*	Partner #2:
Percentage Ownership:	*	Percentage Ownership:
Address 1:	*	Address 1:
Address 2:		Address 2:
City:	*	City:
State:	*	State:
Zip Code:	*	Zip Code:
Country:	*	Country:
Social Security #:	*	Social Security #:
Drivers License #:	*	Drivers License #:
Drivers License State:	*	Drivers License State:

Partner #3:		Partner #4:
Percentage Ownership:		Percentage Ownership:
Address 1:		Address 1:
Address 2:		Address 2:
City:		City:
State:		State:
Zip Code:		Zip Code:
Country:		Country:
Social Security #:		Social Security #:
Drivers License #:		Drivers License #:
Drivers License State:		Drivers License State:

Bank Reference:

Financial Institution:	*	Phone:	*
Branch:	*	Address 1:	*
Account #:	*	Address 2
Representative:	*	City:	*
Representative Phone:	*	State:	*
Representative Fax:	*	Zip Code:	*
		Country:	*

Business References:

Business Name #1:	*	Business Name #2:	*
Reference Contact:	*	Reference Contact:	*
Address 1:	*	Address 1:	*
Address 2:		Address 2:
City:	*	City:	*
State:	*	State:	*
Zip Code:	*	Zip Code:	*
Country:	*	Country:	*
Phone:	*	Phone:	*
Fax:		Fax:
Email:		Email:

Contracting License and Bonding Information:

Contractors License #:	*	Bonding Company Contact:	*
Type:	*	Bonding Company Address 1:	*
Expires:	*	Bonding Company Address 2:
		City:	*
Bonding Company:	*	State:	*
Bond #:	*	Zip Code:	*
Amount:	*	Country:	*
		Phone:	*
		Fax:
		Email:

Refferal:

Sales Representative:	*
How did you hear about Atom Lighting Inc.?	*

Payment Preference:

Accounts which are activated to pay by credit card at the time of each transaction will receive 50% off retail pricing. Accounts which are set up to pay for product orders using 15 day net terms will receive 40% off of retail pricing. Additionally all accounts set up for payment using "Terms (Net 15)" will be required to authorize a "Continuing Personal Guarantee". Please contact our customer service representatives with any payment preference questions via e-mail at service@atomlighting.com or via telephone at 877-922-2866 during normal business hours.

Payment preference:*	Credit Card Payments Terms (net 15) (Please read and agree to the Personal Guarantee below)

Terms of Sale:

1. Payments for all sales are due at Time of Purchase. 2. I understand that there is a SERVICE CHARGE of 1.5% per month (which is an ANNUAL PERCENTAGE RATE of 18%) that will be charged on any balance not paid at the Time of Purchase. SERVICE CHARGE is added to the principal which is compounded. Applicant and/or guarantor(s) agree to pay such SERVICE CHARGES. Applicant and/or guarantor(s) agree to pay all cost of collection including actual attorneys fees, court cost and/or collection agency fees due to Atom Lighting, Inc. as applicants or guarantors breach of the terms of sale, whether or not a lawsuit is brought to satisfy the debt owed Atom Lighting, Inc. by the applicant or guarantor(s). In the event that any suit or collection action is required to enforce the terms of the Trade Account Application and to collect unpaid account balances owing Atom Lighting, Inc., the undersigned agrees that the jurisdiction and venue for any such action shall not be limited to the state and the county in which the materials, goods or services are purchased or received. The undersigned also agrees and submits to the jurisdiction of the Arizona courts and agrees that proper venue for any collection action will be Maricopa County, Arizona. 3. All sales are subject to all other Terms and Conditions of Sale set forth on the pertinent packing list and/or invoice relating to the particular sale. 4. TRADE ACCOUNTS WILL BE REQUIRED TO MAINTAIN A $2,500 SALES VOLUME ANNUALLY. Atom Lighting Inc. reserves the right to cancel applicants account should the applicant not maintain sales volume equal to $2,500 annually or should applicant default on payment to Atom Lighting Inc. at anytime. 5. UNPAID BALANCES ARE SUBJECT TO TRADE ACCOUNT HOLD AND MAY BE REPORTED TO INDUSTRY TRADE GROUP ASSOCIATIONS. 6. Applicant and/or guarantor(s) agree to pay Atom Lighting Inc. a service charge equal to but not greater than the legally acceptable amount on all dishonored checks and/or credit card transactions returned to Atom Lighting Inc. by the bank and/or merchant provider. The above information is provided for the purpose of obtaining a Trade Account with Atom Lighting, Inc. Applicant does warrant and acknowledge that Atom Lighting, Inc. may rely in same, as concerns the execution of this agreement. In the event Applicant is a Sole Proprietor or Partner in the Partnership, that individuals electronic signature hereinafter authorizes Atom Lighting, Inc. to investigate their individual consumer credit report. If Applicant is a Corporation, electronic signature by an individual may be required on the personal and continuing personal guarantee, and when executed permission is granted to Atom Lighting, Inc. to investigate the individuals consumer credit report. Applicant furthermore authorizes Atom Lighting, Inc. to investigate those references listed here and those available, to Atom Lighting, Inc., through industry credit trade group associations. Applicant acknowledges having kept a copy of this credit application for their business records.

I agree to the above listed Terms of Sale.*			Applicants Name: *

Continuing Personal Guarantee:

The undersigned (hereinafter called the Guarantor(s) for and in consideration of the extension of a Trade Account to Applicant by Atom Lighting, Inc. (hereinafter called Atom Lighting) and as an inducement to Atom Lighting to continue to offer goods for sale to the Applicant, the Guarantor(s) jointly and severely, unconditionally guarantee the payment of any and all sums of money as are now, or at anytime hereinafter may be owing Atom Lighting by Applicant or Guarantor(s), as a result of Atom Lightings extension of Trade Account. Guarantor(s) waive notice of: extension of time or modification of terms of sale, settlements or resolutions of disputes, modification of Trade Account terms, default of Applicant. This is intended to be and is a continuing guarantee and shall not be revoked except by written notice to Atom Lighting not to make further sales and deliveries on the security of this guarantee and until the expiration of five (5) days after such notice shall have been received by Atom Lighting by registered mail, return receipt requested. Any such revocation shall be effective only with respect to merchandise shipped and/or delivered after the expiration of said five (5) day period, and shall not affect, in any respect, liability incurred by the Applicant or Guarantor(s), prior to that time. In the event that any suit or collection action is required to enforce the terms of the Trade Account application by the Applicant or Guarantor(s), and to collect unpaid account balances owing to Atom Lighting, the Guarantor(s) agree that the jurisdiction and venue for any such action shall not be limited to the state and the county in which the materials, goods or services are purchased or received. Guarantor(s) also agrees and submits to the jurisdiction of the Arizona courts and agrees that proper venue for any collection action will be Maricopa County, Arizona. The Guarantor(s) electronic signature further acknowledges that specific authorization has been given to Atom Lighting to investigate the Guarantor(s) individual consumer credit report, necessary with this guarantee.

I agree to the above Continuing Personal Guarantee. *	Individual Guarantor:	*
	Social Security #:	*
	Date:	*

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