Credit Request & Certificate of Insurance Request Form

Please complete the following form to request an initial credit line or a credit increase for your customer. You can also request a certificate of insurance (COI) for your customer on this page. If your customer has a contract that needs to be completed or any other related paperwork, please attach those at the bottom of this form.

Urgent Requests

Regular office hours are M-F 8am-5pm Eastern. For after hours requests, please answer the following. NOTE* Non-urgent requests will be handled during our next regular office hours.

This request is being made during regular office hours

Urgent

Not Urgent

Agent Name

Agent Email

McLeod Customer Code

Request Type

Is this a new customer setup or a credit increase for an existing customer?

New Customer Setup

Credit Increase for Existing Customer

Target Credit Line

How much credit are you requesting for this customer?

Does your customer need a certificate of insurance (COI)?

If you select "Yes", please answer the questions below.

Yes

Additional Information

You can add additional information about this customer and any special requirements. If you are requesting a COI, let us know about specific wording such as "additional insured" or "certificate holder" requested on the COI.

Customer Name on COI

Customer Address on COI

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What email should we send the COI to?

"Attention To"

If your customer needs the "Attn To:" field filled out, what name should be listed?

Customer Setup / Credit Request

Credit Request & Certificate of Insurance Request Form

Thank you!

Your request has been submitted to our credit team. We’ll be in touch soon.

Pearce Companies