Commercial Credit Application

Date*

Address*

City/Town*

State

Zip Code*

Phone Number*

Fax Number

Cell Number

Email Address

Federal Tax ID*

Type of Business/Business Description*

Contractors' License # (If Applicable)

Organization Details

Supply the Year & State you are Incorporated in

Please note: if partnership, all partners must sign. If corporation is 2 years old or less, a personal guarantee is required by the principal stockholder(s). Please sign personal guarantee section below.

Years in Business*

Number of Employees*

Resale Number (Resale Card Must be Submitted)*

Please Upload Copy of Resale Card

Max. file size: 300 MB.

Owner(s)/Officer(s) Information

1. First Name*

Last Name*

Title*

Email Address*

Phone Number*

Social Security Number

Driver's License Number*

2. First Name*

Last Name*

Title*

Email Address*

Phone Number*

Social Security Number

Driver's License Number*

3. First Name*

Last Name*

Title*

Email Address*

Phone Number*

Social Security Number

Driver's License Number*

Personal Guarantee

I personally guarantee payment of any and all indebtedness of this corporate account, and agree to be bound by the terms and conditions as stated on this application.

Signature*

*This text field will act as your signature in agreeing to the above.*

Date*

Signature

*This text field will act as your signature in agreeing to the above.*

Date

Signature

*This text field will act as your signature in agreeing to the above.*

Date

Amount of Credit Being Requested*

Do you use Purchase Orders?

Please List Names of Employees Authorized to Charge on Account:*

How Would you like to Receive Your Statements?

Billing Email Address

Baking References

1. Bank Name*

Bank Address*

Phone Number*

Account Number

2. Bank Name*

Bank Address*

Phone Number*

Account Number

Trade References

1. Name of Company*

Company Address*

Phone Number*

Account Number*

2. Name of Company*

Company Address*

Phone Number*

Account Number*

3. Name of Company*

Company Address*

Phone Number*

Account Number*

Background Information

Residential Address*

Do You*

How Many Years?

Monthly Rent/Mortgage

Most banks are now requiring written authorization for any release of financial information. Please fill out the following to authorize that your bank can release any financial information which might be required to open an account with Catalina Paints, to Catalina Industries Inc:

Bank Name*

Bank Number*

Signature*

*This text field will act as your signature in agreeing to the above.*

In consideration of extension of commercial credit by/Catalina Industries, Inc., I agree to the stated terms of sale and agree to pay a service charge of 1.5% per month, 18% APR, on any past due balance plus cost of collection, including attorney fees and costs should legal action be required. By signing this application, I am stating that I understand and agree to the terms as written and I authorize Catalina Industries, Inc., to investigate and confirm the credit and other information provided. I also give Catalina Industries explicit approval to report activity and payment history on this purchase or any purchase hereafter made on credit terms to credit bureaus and other parties who may lawfully receive such information.

Signature*

*This text field will act as your signature in agreeing to the above.*

Date

Signature*

*This text field will act as your signature in agreeing to the above.*

Date

Signature*

*This text field will act as your signature in agreeing to the above.*

Date

Phone

This field is for validation purposes and should be left unchanged.