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NEW ACCOUNT APLICATION

8300 NW 53 Street, Suite 304
Miami, FL 33166
Phone: 305 597 9710
Fax : 305 597 9730


Company Information

Code:
Legal Company Name:
Date: 07-06-2020
Address:
City:
State:
Zip Code:
Country:
Phone:
Fax:
E-mail:

Type Of Business

Corporation Partnership
Proprietorship Other

Years In Business:
Annual Sales in US $ :
Estimated Monthly Purchase Volume US $ :
Dun & Bradstreet (D&B) Number:

Activities of Company

Wholesaler ISP
Retailer Distributor
VAR Other

Legal Representative or Owner:
Authorized Purchaser:
Position:
Phone:
E-mail:
Accounts Payable Contact:
Position:
Phone:
E-mail:

Employer (Federal) I.D No:
Tax Exempt. No:
State of Florida Resale Certificate No:
(a copy of de certificate must be mailed back this form to keep in our files in compliance with Florida law.)


 

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