Credit Card Authorization

Complete the form below to authorize credit card payment for your business account with COS Business Products & Interiors. All fields marked with an asterisk (*) are required.

Credit Card Authorization

COS Business Products & Interiors

Section 1: Agreement Information

This agreement is made between COS Business Product & Interiors (COS) and the Customer

Agreement Date *

Customer's Legal Name *

Doing Business As (d/b/a if any)

Section 2: Account Terms

Upon completion of this form COS agrees to open an account line for the Customer, with limits to be mutually agreed upon. Customer then, in turn, agrees to pay for all purchases made from COS, in full via MasterCard, VISA, American Express or Discover Card. Any exceptions or amendments to these terms must be noted and agreed to by COS under "Addendums" (below).

Section 3: Default Terms

In the event this account should be declared in default by COS, customer agrees to pay all expenses related to the collection of this account, including, but not limited to, collection agencies, legal fees, and court costs.

Section 4: Business Information

Legal Form of Business *

Federal Tax ID# or Owner's SS# (if Partnership or Proprietorship) *

Section 5: Payment Authorization

Authorized Person Name *

Designation *

I hereby agree to allow COS to charge our MasterCard, Visa, American Express, or Discover Card for all purchases made on account.

Card Number *

Expiration *

CVV *

Billing Address (including zip) *

Name as it appears on the card *

Section 6: Verification Rights

COS reserves the right to verify credit worthiness of any organization seeking an account line, the increasing of an existing account line, or any account which has exceeded or violated any of the terms set forth herein. Customer agrees to such verification and agrees to hold harmless COS for pursuing such information and for such decisions as may be made as the result thereof.

Section 7: Service Charges

COS reserves the right to assess a service charge equivalent to 1.5% per month on all charges not paid within stated terms.

Addendum: Credit Limit Terms

Notes / Addendum (Optional)

Attach Supporting Documents (PDF, Excel, Word)

I agree to all terms and conditions stated above and certify that all information provided is accurate. I authorize COS to charge the provided credit card for all purchases made on account. *

Customer Signature (Full Name) *

Title *

Need help? Contact us at 423-624-0011 or mscherzer@cosonline.com