Credit Application

www.coedistributing.com

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

Are you a Reseller of Office Furniture? *

Yes No
Attach Resale Certificate Here *

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Credit Application
General Business Information
Legal Name: *
Trade Name/DBA *
Mailing Address *

Street Address

Street Address Line 2

City State

Zip Code
Ship To Address *

Street Address

Street Address Line 2

City State

Zip Code
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
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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.

JMJS, Inc. dba COE Distributing

Authorization to Investigate Trade References
Do you have a Reference Sheet to attach? *

Yes No
Please attach Reference Sheet below.. *

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Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Account #:
Contact Person:

First Name Last Name
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Account #:
Contact Person:

First Name Last Name
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Account #:
Contact Person:

First Name Last Name
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
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 *

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Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Account #:
Contact Person:

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:

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