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Online Cash Account Application

Is this for a new account or address change?

Account Name

Account Number (for address change)

Street Address*

City/Town*

State*

Zip*

Business Phone

Fax Number

Email Address

Federal Tax ID*

Sales Tax Exemption # (If yes, attach copy)

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Please attach copy of tax exemption

Type of business*

CONTACT PERSON RESPONSIBLE FOR PAYMENTS/ACCOUNT

First Name*

Last Name*

Social Security #*

Cell Phone #

Email Address

Number of Painters*

Year Business Began*

Estimated Monthly Purchases*