Customer Application

Step 1 of 5 – Company Information

Comments
This field is for validation purposes and should be left unchanged.
ColorCoat Plant Location*
Company Information
Company Name*
Physical Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Fax
Federal Tax ID Number
Please enter a number greater than or equal to 0.
Description of Business
Organization Type
- Sole Owner
- Corporation
- S-Corp.
- LLC
- Partnership
State of Incorporation
Year
Resale Number (if applicable)

Accounts Payable
We accept checks or wired funds. We do not accept credit cards.
Address*
Street Address Address Line 2 City State ZIP Code
Accounts Payable Contact Name*
First Last
Email*
Phone*
Fax
Date Revised*
Month
Day
Year
Update Approved By:*
First Last

Trade Funds
Open credit accounts; no credit cards accepted.
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Fax
Account Number
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Fax
Account Number

Sign & Submit
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Fax
Account Number
Authorized Signature*
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Date
MM slash DD slash YYYY
Name
First Last
Title
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