Customer Registration

Name *

First

Last

Job Title *

Company Name *

Business Name *

Information about your business *

Main Email *

Main Phone *

Delivery Address *

Address Line 1

Address Line 2

City

State

Zip Code

Delivery Access Details *

Opening time | Earliest time we can deliver | Gate code and/or lockbox code | Specific delivery instructions.

Repeat Address

Billing Address

Address Line 1

Address Line 2

City

State

Zip Code

Estimated Monthly Purchase Volume *

Select your preferred payment method *

Debit/Credit (Your information will be saved as the preferred method at checkout.)
ACH Direct Debit (Your information will be saved as the preferred method at checkout)
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)

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 & Conditions

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