New Customer - Integrated Openings Solutions

New Customer Form

Company Name

DBA

Address

City

State/Province

Zip Code

Country

Phone

Billing Address

Billing City

Billing State/Province

Billing Zip Code

Billing Country

Tax Identification #

Type of Business

# of Years in Business

# of Employees

Previous Address

Website

Resale License / Tax Exempt #

Subsidiary Corporation

Yes No

If yes, parent company

Sales/Project Contact Information

First Name

Last Name

Title

Phone

Accounting Contact Information

First Name

Last Name

Title

Phone

Are you applying for credit?

Yes No

Previous Company Information (only needed if in business for less than a year)

Previous Company

Address

State

City

Zip Code

Country

Credit Reference #1

Company

Contact Person

Phone Number

Fax

Credit Reference #2

Company

Contact Person

Phone Number

Fax

Credit Reference #3

Company

Contact Person

Phone Number

Fax

Please Review and Confirm Agreement with the Following Documents

Please Provide W-9

If yes, complete the following or attached your credit reference here

Please Provide Tax Exempt Certificate

Signature