Customer Application

Collects the legal, tax, and contact details a business needs to open a new commercial account for a customer.

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Company Information

Legal company name

Doing business as (alternative names)

Website

Type of entity

Sole proprietorship Partnership Corporation LLC

Address

Street Address

City

State / Province

ZIP / Postal Code

Contact Person

First Name

Last Name

Title

Phone

Email

Federal ID #

D & B #

Accounts Payable Contact

Phone

Email

Purchases are

For resale For own use Tax exempt

I certify that the information provided is true and accurate

Signature

Sign here

Date

Printed Name

First Name

Last Name

Title

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