iCoat - Become Customer

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Completely fill out the New Account Application form below and click Submit.

You can also download the application in PDF format; print and then hand write the application. Please fax the application to iCoat Company at ( 866 ) 946-1060.

New Account Information	Recommended

Contact Name :
Business Proprietor's Name (Business Owner) :
Business Trade Name :
Parent Company Name (If Subsidiary) :
Business License Number (Resale #) :
Business Address :
City :
State :
Zip :
Phone :
Fax :
Years in Business :
Years at Present Location :

Bank Reference
Name of Bank :
Name :
Checking Account Number :
Address :
City :
State :
Zip :
Phone :
Bank Contact :

Business References (a minimum of three are required)
Reference 1 :
Name :
Account Number :
Address :
City :
State :
Zip :
Phone :
Contact :

Reference 2 :
Name :
Account Number :
Address :
City :
State :
Zip :
Phone :
Contact :

Reference 3 :
Name :
Account Number :
Address :
City :
State :
Zip :
Phone :
Contact :

Terms and Conditions
Terms are net, 30 days E.O.M. A service charge of 1.5% (18% APR) will be applied to all balances unpaid after thirty (30) days E.O.M. iCoat Company reserves the right to amend the terms and conditions of this agreement anytime by written notice. iCoat Company reserves the right to decline its service to anyone at any time. I, the undersigned, hereby agree that in the event of default in the payment of any amount due on this account, I will be personally liable for the unpaid balance. Also, in the event this account is placed in the hands of an agency or attorney for collection, I am responsible to pay all the charges equal to the cost of collection including agency and attorney fees and the court costs incurred and permitted by laws governing these transactions. I also certify that all the information and statements in this application are true and complete and are made for the purpose of obtaining credit. I give iCoat the right to contact any references listed.
I agree the terms and conditions