Orders: (800) 535-3885  
 
 
  
Credit Application
 

You can apply for credit by submitting the online form below. If you prefer, you can also download the forms and apply for credit via:

  • Email: credit@coolantcontrol.com
  • Fax: (513) 471-2721
  • Mail: Coolant Control Inc, 5353 Spring Grove Ave, Cincinnati, OH 45217
   
 
Company Name:   Application Date:
Phone:   Fax:
         
 Shipping Information
 Shipping Address
 Shipping City:
 Shipping State:
 Shipping Zip Code:
 
 Billing Information
 Billing Address
 Billing City:
 Billing State:
 BIlling Zip Code:
         
Freight Terms:   Prefered Carrier:
         
 Purchasing Information
 Purchasing Contact:
 Phone:
 Email:
 
 A/P Information
 A/P Contact:
 Phone:
 Email:
         
FEIN / SSN:    
Sales Tax Exempt:



  If you selected Yes, please download and fax a completed tax exempt certificate to (513) 471-2721. (Download certificates for IN, KY, MI, OH)
         
Business Description:
         
Trade References
1. Name: Contact:
  Street: City:
  State: Zip Code:
  Phone: Fax:
2. Name: Contact:
  Street: City:
  State: Zip Code:
  Phone: Fax:
3. Name: Contact:
  Street: City:
  State: Zip Code:
  Phone: Fax:
         
Bank References
1. Name: Contact:
  Street: City:
  State: Zip Code:
  Phone: Fax:
  Account Number(s): Account 1 Account 2
2. Name: Contact:
  Street: City:
  State: Zip Code:
  Phone: Fax:
  Account Number(s): Account 1 Account 2
         
READ CAREFULLY

The undersigned applicant certifies that they are the owners or authorized representative of the applicant and attest to the applicant’s financial ability and willingness to pay Coolant Control’s invoices in accordance with the following terms: Net 30 days from date of invoice for lubricants, and Net 10 days from date of invoice for diesel and kerosene unless otherwise specified and approved. Should invoices become past due, applicant agrees to pay a finance charge computed at the rate of 1.5% per month (18% Annual Percentage Rate) or the maximum allowed by law until the invoices are paid. Applicant will be responsible for all collection costs including legal fees.

The above information is for the purpose of obtaining credit and is warranted by the undersigned to be true. Applicant hereby authorizes the references listed on this application to disclose full credit and financial information concerning the applicant to Coolant Control, Inc. now, or if at any time in the future Coolant Control, Inc. wishes to update it’s credit files.
I agree with the terms and conditions stated above
Completed By:
Title:
Date: