Cash On Delivery (COD) Application

CASH ON DELIVERY (COD) APPLICATION

To create a COD account with BR Supply, fill out the form below, and push the Submit button. You will be contacted when your account is created and ready for use.

**REMINDER: This is NOT a request for a charge account. If you would like a charge account, please return to the Credit Application page, and complete either the Business or Personal Credit Application (whichever is applicable to you).

Required fields are marked with an asterisk (*)

Account Name: *

Contact Name:

Address: *

City: *

State: *

Zip Code: *

County: *

Phone: *

Cell Phone:

Email Address: *

Is your account non-taxable? *

Yes
No

Do you have an EPA certification? *

Yes
No

If this account is non-taxable, attach your sales tax exemption form here:

You can only upload .doc, .docx and .pdf files up to 10MB.

If you have an EPA certification, attach a copy of your card here:

You can only upload .doc, .docx and .pdf files up to 10MB.

I prefer to mail or drop off a copy of my EPA certification.

Primary Store Location:

Sales Rep (if any):

Additional Information

If you have questions, please contact our Credit Applications department:

Phone:	731-784-1895
Email:	[email protected]

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CASH ON DELIVERY (COD) APPLICATION