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 your Bank Account Information)Check (To qualify for 7 to 10 days of credit, you must to complete your Bank Account Information)Cash (Does not qualify for credit, payment must be made at the time of delivery)Bank NameAccount NumberRouting NumberPayment 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 by completing the Bank Account Information, either during checkout or later under My Account > Payment Methods. I also understand that, when placing an order using my approved payment terms, I must select the "Pre-approved Payment Terms" option during checkout. 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 prior notification before any charge is processed. Invoices are due seven (7) calendar days after delivery and must be paid no later than ten (10) calendar days from the delivery date. Any payment terms extending beyond ten (10) days must be authorized in writing by Coto Distributors Inc. I also understand that a $20.00 fee will be charged for any returned or dishonored checks.Payment by Debit/Credit Card – Authorization and TermsI understand that I will be paying by Debit/Credit Card, and I agree to securely register my payment method either during checkout or later under My Account > Payment Methods. I understand that payments made by Debit/Credit Card require immediate payment at checkout, and that I must select the Debit/Credit Card payment option during checkout when placing an order using this payment method. I understand that payments are processed directly by the selected payment provider (such as Stripe, Apple Pay, Google Pay, Klarna, Afterpay, Cash App Pay, Affirm, or other available payment methods) and are not managed or charged directly by Coto Distributors Inc. I acknowledge that Coto Distributors Inc. does not store or process my payment information directly, and that all transactions are securely handled by the selected third-party payment provider. I further understand that any payment disputes, authorization issues, financing terms, or installment plans (if applicable) are governed solely by the policies of the selected payment provider.Payment by ACH Direct Debit – Authorization and Terms I understand that I will be paying by ACH Direct Debit, and I agree to register a valid Bank Account by completing the Bank Account Information in this form, either during checkout or later under My Account > Payment Methods. I also understand that, when placing an order using my approved payment terms, I must select the "Pre-approved Payment Terms" option during checkout. I authorize Coto Distributors Inc. to initiate ACH debit entries from the bank account listed above for amounts due on invoices generated from orders placed with Coto Distributors Inc. This authorization applies to variable invoice amounts, including but not limited to product purchases, delivery fees, returned payment fees, and any other approved charges related to my customer account. Invoices are due seven (7) calendar days after delivery and must be paid no later than ten (10) calendar days from the delivery date. Any payment terms extending beyond ten (10) days must be authorized in writing by Coto Distributors Inc. I understand that ACH payments may be automatically debited from my authorized bank account on or after the invoice due date, unless another written payment agreement has been approved by Coto Distributors Inc. I am responsible for providing accurate bank account information and notifying Coto Distributors Inc. immediately of any changes. This authorization will remain in effect until Coto Distributors Inc. receives my 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