Credit Application

Corporate Headquarters
1020 Franklin Drive, Suite 5
Phone: 800-388-8202
Fax: 866-437-6037
Email: accounting@coedistributing.com

Remit To Address:
PO Box 536577
Pittsburgh, PA 15253-5907

Mailing Address *

Ship To Address *

Receiving Hours *
Dock Available?

Yes No
Special Receiving Instructions
Phone Number *

- Area Code Phone Number
Fax Number

-
DUNs Number: *
Federal Tax ID *
Principal/Owner/Officer *

First Name Last Name
Title
Indicate Type of Business: Proprietorship, Corporation, LLC, Etc.
Date Business Started

/ Month / Day Year
Date
Are You Tax Exempt?

Yes No
Estimated Annual Sales
% Of Furniture Sales
Company Website
Credit Limit Requested *
Company Contact Information
Accounts Payable Contact

First Name Last Name
Phone Number

-
Email Address
example@example.com
Sales/Marketing Contact

First Name Last Name
Phone Number

-
Email Address
example@example.com
Order Confirmation - Email Address
example@example.com
For the box below you will sign your name digitally using your mouse. This notifies us that you understand and agree to what you have read above and are ready to move forward.
Signture *

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Title
For the box below you will sign your name digitally using your mouse. This notifies us that you understand and agree to what you have read above and are ready to move forward.
Print Name *

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Date *

/ Month / Day Year
Date
Applicant: Please Complete Trade References For Determination Of Credit Approval, Review And Sign Payment Agreement And/Or Gurantee. Be Sure To Include A W-9 and Proof Of Your Sales Tax-Exempt Status. No Application Is Complete Without All Of The Above.

Account #:
Contact Person:

First Name Last Name
Have More References? *

Yes No
Please download the attached Authorization to Investigate Trade References document if necessary.

Download Here!
Submit Authorization Document Here *

Browse Files

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Name

First Name Last Name

Payment Agreement
Please download and fill out the attached Payment Agreement.

Payment Agreement
Once completed, please submit the form below.
You may also email it to us at accounting@coedistributing.com
or fax it to 866-437-6037
Submit Form Here: *
Initials *

Guaranty
Please download and fill out the attached Guaranty Document.

COE Guaranty
Once completed, please submit the form below.
You may also email it to us at accounting@coedistributing.com
or fax it to 866-437-6037
Submit Form Here:
Initials

W-9 Form
Please download and fill out the attached W-9 form.

W-9 Form
Once completed, please submit the form below.
You may also email it to us at accounting@coedistributing.com
or fax it to 866-437-6037
Submit Form Here: *

Credit Card Authorization
If you wish to pay by credit card, please fill out and attach the document below.

Credit Card Application
Once completed, please submit the form below.
You may also email it to us at accounting@coedistributing.com
or fax it to 866-437-6037
Submit Form Here:

Authorization Agreement

ACH Preauthorized Payments (Debits)
If you wish to pay by ACH, please fill out and attach the document below.

Authorization Agreement
Once completed, please submit the form below.
You may also email it to us at accounting@coedistributing.com
or fax it to 866-437-6037
Submit Form Here:

If you are ready and have filled out everything to the best of your ability please submit form below.

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