Credit Application Your Trusted Source for Premium, Eco-Friendly Building Materials Application For Credit Firm Name: Address City State / Province Zip Code Telephone Fax Website Business Information *Type of Business: AGENT OEM DISTRIBUTOR A/P Contact Name Title Telephone Extension Fax Email Address State of Company Registration FMC / Brokerage License BANK INFORMATION Name of Bank Account Number Address City State / Province Zip Code Contact Person Telephone Email Fax ***NOTE: PLEASE INCLUDE A LETTER AUTHORIZING COASTAL CUSTOM PRODUCTS TO CONTACT THE BANK REFERENCE TO AVOID PROCESSING DELAYS*** TRADE REFERENCES Name Address City State / Province Zip Code Send