CREDIT APPLICATION

Cotswold is able to extend credit to most qualified applicants.

Please complete the online application below.

Or, click here to download the Credit Application.

Once completed, please fax to 212-545-0603, or email to info@cotswoldindustries.com.

COTSWOLD INDUSTRIES - CREDIT APPLICATION

ACCOUNT INFORMATION - Fill out below

ACCOUNT NAME:

Name of Person Filling Out This Form:

Year Incorporated:

# of Employees

BILL-TO COMPANY:

Street:

City/State/ZIP:

Phone #:

DUNS #:

SHIP-TO COMPANY:

Street:

City/State/ZIP:

Fax #:

E-mail:

BANKING REFERENCE #1 (required)

Name of Bank:

Address:

Phone #:

Fax #:

Name of Contact:

E-mail:

BANKING REFERENCE #2

Name of Bank:

E-mail:

Address:

Phone #:

Fax #:

Name of Contact:

TRADE REFERENCE #1 (required)

Name of Company:

Address:

Phone #:

Fax #:

Name of Contact:

E-mail:

TRADE REFERENCE #2

Name of Company:

Address:

Phone #:

Fax #:

Name of Contact:

E-mail:

TRADE REFERENCE #3

Name of Company:

Address:

Phone #:

Fax #:

Name of Contact:

E-mail:

TRADE REFERENCE #4

Name of Company:

Address:

Phone #:

Fax #:

Name of Contact:

E-mail:

TRADE REFERENCE #5

Name of Company:

Address:

Phone #:

Fax #:

Name of Contact:

E-mail:

TRADE REFERENCE #6

Name of Company:

Address:

Phone #:

Fax #:

Name of Contact:

E-mail:

12 + 9 =