Credit Application

PLEASE FILL OUT THE FORM BELOW TO THE BEST OF YOUR ABILITIES, OR RETURN COMPLETED APPLICATION VIA FAX: 317-733-4450 ATTENTION: TAMI LAMAR or email to: tami@americancoated.com

New Account:
Tax Exempt Number:

Full Legal Name of Business
Address:
City, State Zip:	,
Telephone:
Fax:

President or Principal Owners:

Account(s) Payable Contact (Address, Phone, Email, etc..):
Purchaser(s)/Buyers Contact (Address, Phone, Email, etc..):

Bank Reference:
Address:
City, State Zip	,
Telephone Number:
Fax:

DUNS Number:
Length of Time in Business:
Type of Business:

Credit References (Please list at least 3):
Name, Address, City, State, Zip, Phone, Fax:

Estimated Monthly Credit Requirements:

THE ABOVE INFORMATION IS BEING SUBMITTED FOR THE PURPOSE OF ALLOWING AMERICAN COATED PRODUCTS TO ASSESS AND/OR CONTINUE TO ASSESS CREDIT ON THE UNDERSIGNED ACCOUNT. THE UNDERSIGNEDHEREBY REPRESENTS AND WARRANTS THAT THE INFORMATION CONTAINED HEREIN, OR SUBMITTED IN CONNECTION HEREWITH, IS TRUE AND COMPLETE AS OF THE DATE HEREOF. WE HEREBY AUTHORIZED AMERICAN COATED PRODUCTS TO CONTACT AND INVESTIGATE THE REFERENCES, INCLUDING THE BANKS LISTED ABOVE AND WE AUTHORIZE THE REFENECE TO RELEASE THE REQUESTED INFORMATION. THE UNDERSIGNED HEREBY AGREES TO REMIT PAYMENT WITHIN THE TERMS SPECIFITED ON THE FACE OF THE INVOICE. IF THE ACCOUNT IS PLACED FOR COLLECTION, THE UNDERSIGNED AGREES TO PAY ALL COSTS AND EXPENSES OF COLLECTION, INCLUDING ATTORNEYS’ FEES AND EXPENSES.

Full Name:

Signed (Type your name again as this will be used as a E-Signature)

Date: