Credit Request

Please note that this form is for the use by Axalta Authorized Distributors only. It is for requesting valid one-time credits (not ongoing or repeating requests). Only costs incurred in the last 90 days will be considered (pursuant to the Distributor Operations Manual).
Distributor Information

Question Title

* Distributor Name

Question Title

* Distributor Account Number 
This number indicates which account approved credits should be posted to.
If you are unsure what number to use, your Axalta Representative can assist you.

Question Title

* Contact information
Please enter your contact information. This information will be used to verify authenticity of this request and provide you with confirmations through the credit process.

Please note, if you are testing or training on this site and not submitting a real request, please use the email address test@test.com.

Question Title

* This one-time credit is being requested because a product, service, support, etc. was provided to:

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