Customer Registration Please fill out this form Please enable JavaScript in your browser to complete this form.Name *FirstLastJob Title *Company Name *Business Name *Information about your business *Main Email *Main Phone *Delivery Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDelivery Access Details *Opening time | Earliest time we can deliver | Gate code and/or lockbox code | Specific delivery instructions.Repeat AddressBilling Address same as Delivery AddressBilling AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEstimated Monthly Purchase Volume *Under $800$800-$4000$4000-$10000Over $10000Select your preferred payment method *Debit/Credit (Your information will be saved as the preferred method at checkout.)ACH Direct Debit (Complete the Bank Account Payment Authorization Form)Check (To qualify for 7 to 10 days of credit, you must register Bank Account as your payment method)Cash (Does not qualify for credit, payment must be made at the time of delivery)Bank Account Payment Authorization Form Complete and send this form Payment by Check – Authorization and TermsI understand that I will be paying by check, and I agree to register a valid Bank Account as a backup payment method, completing theBank Account Payment Authorization Form. I acknowledge that my check will be the primary form of payment, and that the backup payment method will not be charged unless I fail to comply with the agreed payment terms. In such case, I understand that I will receive a notification prior to the charge being processed. Invoices are considered due seven (7) days after delivery and must be paid no later than ten (10) days from the delivery date. Any alternative payment terms beyond 10 days must be authorized in writing by Coto Distributors Inc. I also understand that a $20 fee will be charged for any returned or dishonored checks.Payment by Debit/Credit Card – Authorization and TermsIf you choose to pay via Debit/Credit Card, or any available digital payment method (including but not limited to Stripe, Apple Pay, Google Pay, Klarna, Afterpay, Cash App Pay, or Affirm), you agree to complete payment at the time of checkout by securely registering and processing your payment through the selected platform. These payment methods are processed directly by the selected payment provider and are not managed or charged by Coto Distributors Inc. By selecting any of these options, you acknowledge and agree that: These payment methods do not qualify for credit terms (Net 7 or otherwise). Payment is due immediately at checkout. Coto Distributors Inc. does not store or process your payment details directly; all transactions are handled by third-party providers. Any payment disputes, authorization issues, or financing terms (if applicable) are subject to the policies of the selected payment provider. If your account has previously approved payment terms (Net 7 or other), you must select the “Pre-approved Payment Terms” option at checkout to use those terms.Payment by ACH Direct Debit – Authorization and Terms If you choose to pay via ACH Direct Debit, you authorize Coto Distributors Inc. to debit your bank account for invoices related to orders placed with our company, according to your approved payment terms. To activate ACH Direct Debit, you must complete, sign, and return the Bank Account Payment Authorization Form provided. The completed form may be scanned or photographed clearly and emailed to customerservice@cotofd.com Each invoice will show the amount and net terms. By selecting ACH Direct Debit, you understand that payments may be automatically debited from your authorized bank account on or after the invoice due date, unless another written agreement has been approved by Coto Distributors Inc. You are responsible for providing accurate bank account information and notifying us immediately of any changes. This authorization will remain in effect until Coto Distributors Inc. receives written notice of cancellation or updated payment authorization. Authorization and Agreement Confirmation *I confirm that I am an authorized representative of the business and that all information provided is true and accurate. By submitting this form, I confirm that I have read and agree to the Terms & Conditions and Privacy Policy of Coto Distributors Inc., including payment terms, credit terms (if applicable), delivery policies, and consent to receive transactional and operational communications related to my account.By clicking Submit I accept the Privacy Policy and Terms & ConditionsSubmit
