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Cash on Delivery (COD) Online Application

Please fill out our Cash on Delivery (COD) Application below. If you have any questions, please do not hesitate to contact us at either of our store locations.

Company Name*

Your First Name*

Your Last Name*

Address*

City/Town*

State*

Zip Code*

Phone Number*

Fax Number

Cell Number

Email Address

Today's Date*

Number of Painters*

Year Business Established*

Estimated Monthly Purchases $*

Tax Exempt Number (If Applicable)

Business Category (ex: Painter, Builder, Designer, etc)*

Where do you currently purchase paint?