Become iCoat Customer

Account Application

Thank you for your interest in becoming an iCoat customer. Completely fill out the New Account Application form below and click Submit. Alternatively, you can download the application in PDF format; print and then hand write the application. Please fax the application to iCoat Company at (562) 946-1060.

NEW ACCOUNT INFORMATION
Business Trade Name*
Parent Company Name (If Subsidiary)
Owner's Name*
Business License Number (Resale #)*
Business Address*
City*
State*
Zip*
Email*
Phone*
Fax*
Years in Business*
Years at Present Location*
Contact Name*
How much Monthly Credit are you applying for?*
BANK REFERENCE
Name of Bank*
Contact Name at Bank*
Checking Account Number*
Address*
City*
State*
Zip*
Phone*
BUSINESS REFERENCES
A minimum of three are required
Reference 1
Business Name
Account Number
Address
City
State
Zip
Phone
Contact Name
Reference 2
Business Name
Account Number
Address
City
State
Zip
Phone
Contact Name
Reference 3
Business Name
Account Number
Address
City
State
Zip
Phone
Contact Name
TERMS AND CONDTIONS
1. Terms are net, 30 days E.O.M.
2. A service charge of 1.5% (18% APR) will be applied to all balances unpaid after thirty (30) days E.O.M.
3. iCoat Company reserves the right to amend the terms and conditions of this agreement anytime by written notice.
4. 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.
Agreement*
- I agree to the terms and conditions of iCoat
Name of the Financially Responsible Officer*
Title of the Officer*
Signature*
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NEW ACCOUNT INFORMATION

BANK REFERENCE

BUSINESS REFERENCES

Reference 1

Reference 2

Reference 3

TERMS AND CONDTIONS

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