Apply for Credit with PaintAndCarpet.com

There are two ways to apply: 1. Use our secure online form below to submit your information electronically, or 2. Download a PDF of the credit application, fill it out and send to your Corporate Source account manager.

"*" indicates required fields

Name / Address

First Name*

Last Name*

Company Name*

Title*

Tax I.D. Number*

Address*

Address Line 2

City*

State*

Zip code*

Email Address

Phone Number*

Bank References

Checking Institution Name

Checking Account #

Savings Account #

Hidden

Checking Address

Hidden

Checking Phone

Bank Name

Bank Address

Bank Phone

Home Equity Institution Name

Home Equity Institution Loan

Loan Balance

Home Equity Institution Address

Home Equity Institution Phone

Trade References

Company Name #1

Contact Name #1

Address #1

Phone #1

Email #1

Account Opened Since #1

Credit Limit #1

Current Balance #1

Company Name #2

Contact Name #2

Address #2

Phone #2

Email #2

Account Opened Since #2

Credit Limit #2

Current Balance #2

Company Name #3

Contact Name #3

Address #3

Phone #3

Email #3

Account Opened Since #3

Credit Limit #3

Current Balance #3

Signature

I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein.

Date*

Signature*

ACH and Credit Card fees: A word of explanation re ACH and Credit Card fees. Banks and Payment Processing Companies charge fees that originate from YOUR choice of payment option. These fees are set by the processing companies; NOT by our firm. We do not profit from these fees, they go straight to the processing firm re ACH and Credit Card processors. Paying by traditional check does not cost you, or us, a fee. These processing fees are unrelated to the products, services of our firm as it serves you. These fees are ONLY caused by your choice of payment. The use of ACH and Credit Card payments is a convenience to you, thus our decision to pass along the fee for that convenience to you.

Apply for Credit with PaintAndCarpet.com

Name / Address

Company Information

Bank References

Trade References

Signature

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