å

New Client Information

Your name here please:*
E-mail:*
Company:*
Street address:*
City:*
State:*
ZIP:*
Business Information
Mailing address:
City:
State:
ZIP:
Main contact:
Office phone:
Fax numbet:
Federal tax id number:
Sales tax exempt number (must provide certificate):
Sales tax exempt certificate:
Do you require P.O. numbers:
- No
- Yes
Busyness type:
- Corp.
- LLC
- Partnership
- Sole Prop
- Other
Other busyness type:
Accounts payable contact
Contact:
Phone:
E-mail:
Trade References
Company name:
High credit:
Phone:
E-mail:
Company name:
High credit:
Phone:
E-mail:
Company name:
High credit:
Phone:
E-mail:
Financial references
Bank Name:
Address:
Account number:
Contact name:
Year of relationship:
Phone:
E-mail:
Credit reference name:
Address:
Account number:
Contact name:
Year of relationship:
Phone:
E-mail:
Other Information
Who is your Pride Group contact:
Provide current W-9:
- No
- Yes
Relationship desired:
- Long Term
- Short Term
Please upload your W9 here:
DOWNLOAD THE W-9 FORM HERE
Additional Notes
Notes:
Signature
I hereby authorize Pride Group, LLC to investigate the information supplied herein. I also authorize my bank and other financial institutions and suppliers of credit as listed herein to share with Pride Group their experience. Authorization is granted to use electronic copies of signatures to obtain authorization.
Signature:*
Title:*
Date:*
Date Format: MM slash DD slash YYYY