Company Information
Code:
Legal Company Name:
Date: 10-13-2024
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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