Pro Account Cash Application Form - Champions of Colour

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For
Professionals

Pro Account Cash Application Form

Country*
Account Name/ Business*
Contact Person*
Tel*
Mobile
Fax
Email
Address*
Estimated Average Annual Paint & Coatings Spend*
Business Description
- Painting Contractor
- General Contractors, Renovation and small construction
- Building Construction, Large residential & commercial
- Property Maintenance Contractor
- Furniture / Wood Works
- Metal Work
- Engineering
- Architect / Designer
- Hotel
- Real Estate & Villa Management
- Commercial Business
- Offices / Professional Services
- Manufacturing
- Heavy Industry / Utilities
- School
- Hospital
- Government Institutions / Infrastructure
- Other
Check the box that applies to you*
- I am new to shopping at Harris/BH Colourcentres
- I am an existing shopper at Harris/BH Colourcentres
*
- YES I certify that I am authorized to open the account in the above name and the information provided in this form is true and accurate.
- YES I agree to be contacted by Harris Paints about special offers, events, new products or other information relating to Harris products or services or those of a partner organization, by email, text, telephone or mail. I understand that my contact information will be kept confidentially and will not be made available to third parties.
Name
This field is for validation purposes and should be left unchanged.

REV 1 – 15 JUNE 2016 HPIL-FRM-79

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