ILC New Customer Registration

New Customer Registration

Company Name *

Street Number and Name *

Bldg. / Suite / Apt.

City *

State *

Zip Code *

Phone Number *

Website

Primary Contact

First Name *

Last Name *

Email Address *

Office Phone *

Office Extension

Mobile Phone

Fax

Billing Information

Is the accounts payable contact the same as the primary contact above? *

Yes

No

Accounts Payable Contact

First Name

Last Name

Phone Number

Mobile Number

Fax Number

Email Address

Will your company be renting equipment from ILC? *

No

Yes

Is your company exempt from Chicago rental tax? *

No

Yes

Upload Certificate Of Insurance (naming “Intelligent Lighting Creations, Inc.” as an additional insured) *

Upload Tax Exempt Document

Is your company exempt from Illinois sales tax? *

No

Yes

Upload Tax Exempt Document

Is the billing address the same as the shipping address above? *

Yes

No

Billing Street Number and Name *

Billing Bldg. / Suite / Apt.

City *

State *

Zip Code *