Credit Application

Company Information

If your company is tax-exempt, please send your tax exemption certificate to
Company *
Location *

Trade References

Phone numbers need to be 10 digits ONLY with no special characters (i.e. 7706061539 NOT 770-606-1539).
Company 1
Company 2
Company 3
Company 4

Bank References

Company 1
Company 2

Company Details

Business Type *

Accounting Contacts

AP Contact
Purchasing Contact

Sales Tax Status

The undersigned certifies that all tanglible personal property to be purchased from Energy Systems Southeast, LLC will be exempt from the Sales Tax for:
for the following reason: *
If such property or any portion thereof which is purchased pursuant to thus certificate is determined to be subject to such tax, it is agreed that such tax will be paid by the undersigned.

Authorizations and Signature

I, the applicant, understand and agree to meet Energy Systems Southeast's terms of sale, to pay any service charges assessed, and to pay reasonable attorney fees in the event of default.
I hereby authorize Energy Systems Southeast, LLC or its agents/assigns to verify or investigate any and all of the foregoing statements made in conjunction with an application for business funding/leasing verification. This includes but is not limited to my/our credit worthiness and financial responsibility in any way they may choose.
I/we grant authorize Energy Systems Southeast, LLC the right to procure any and all credit reports pertaining to any party listed on the application for business funding/leasing including but not limited to all principals of the applicant company. 
The undersigned verifies that all information provided in each section of the Credit Application is current and accurate as of the date submitted.
Agreed and consented to by:
Signature of Authorized Purchaser *
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