Lighting Showroom Career Opportunities Customer Info Home About Us Products Services Industries Served Locations SHOP Branch Locations BROUSSARD, LA (337) 839-0948 LAFAYETTE, LA (337) 234-7427 LAKE CHARLES, LA (337) 436-6676 CUSTOMER INFORMATION Name* First Last Email Phone Fax Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Nature of Business* Business Type* LLC Incorporated Individual Date Company Started Business* Line of Credit Requested* Estimated Monthly Purchases* PRINCIPAL OFFICERS/OWNERS 1st Principal Officer / Owner Information Name* First Last Residence Phone* 2nd Principal Officer / Owner Information Name First Last Residence Phone 3rd Principal Officer / Owner Information Name First Last Residence Phone Purchasing Contact Accounts Payable Contact TRADE REFERENCES Please fill out completely 1st Trade Reference Name* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone* Fax 2nd Trade Reference Name* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone* Fax 3rd Trade Reference Name* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone* Fax BANK REFERENCES Please fill out completely Bank Name* Officer Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone* Fax Does your company require purchase orders?* Yes No Should we charge sales tax?* Yes No If No (to charging sales tax), please attach a copy of your tax exemption certificate. Without this certificate on file, we must charge taxes. Max. file size: 50 MB. Does your firm or any of it s principal officers, have or have had an account with TECHE ELECTRIC SUPPLY, LLC?* Yes No If yes to your firm having an account with us, please furnish us with that name. TERMS OF SALE: NET 30 DAYS By submitting this application, I authorize TECHE ELECTRIC SUPPLY, LLC or its agency to investigate my personal credit financial records. As part of such investigation, I authorize TECHE ELECTRIC SUPPLY, LLC to request and obtain credit reports on me in connection with the opening, monitoring renewal and extension of this and other accounts with TECHE ELECTRIC SUPPLY, LLC and the marketing of other products and services to me and my business by TECHE ELECTRIC SUPPLY, LLC. I further authorize TECHE ELECTRIC SUPPLY, LLC to share the information received from my consumer report with TECHE ELECTRIC SUPPLY, LLC parent, subsidiaries and affiliates (and others if applicable). If I request, you will tell me whether my consumer report was requested and if so the name and address of the consumer credit agency that furnished the report. Any misrepresentation in this application will be considered evidence of a fraud, since this information is the basis of the granting of credit. As an inducement to grant credit, the undersigned warrants that the information submitted is true and correct. You are authorized to investigate the credit references listed. CONTINUING GUARANTY The Undersigned (“GUARANTOR”) in consideration of the extension of credit to (“CUSTOMER”) by Teche Electric Supply, LLC (“CREDITOR”) hereby guarantees the full and timely payment and performance of all the obligations and indebtedness of Customer to Creditor. Guarantor’s obligation hereunder shall be in solido with the Customer. Guarantor further agrees that in event it becomes necessary to place this Continuing Guaranty in the hands of a collection agency or an attorney for collection, guarantor shall also pay all actual fees, attorney fees, expenses, court costs, or 25% of the total amount of the total amount owed in principal and interest, whichever is greater. GUARANTOR'S SIGNATURE Company Name* Guarantor's Signature* To sign,tType your name with the following in front of your name: /s/ Printed Guarantor's Name* Address* City State / Province / Region Date* MM slash DD slash YYYY CAPTCHA Our Vision We are Teche Electric Supply...and this is our vision. We are working together for a brighter tomorrow...for Teche Electric Supply, its employees, and its customers. It’s a team effort, and we are all committed to do whatever it takes to carry out this vision every day. We are Teche Electric Supply...and we’re working with you for a more productive tomorrow! Value-Added Services Delivery 24/7 Emergency Services Convenient Credit Options Unmatched Inventory Commitment to Customer Service After Hours We realize that situations arise during non-business hours. For this reason, we do offer After-Hours callout service. This service is available 24 hours a day, 7 days a week, 365 days a year. Contact your local Teche Electric location for their specific policy. A $75 call out fee is charged for all After-Hour callouts. Disclaimer Terms & Conditions Cookie Policy Privacy Policy Site Map © 2021 Teche Electric Supply, 410 Eraste Landry Road, Lafayette, LA 70506. Web site by Let's Talk Klout 9!