| Legal Company Name: |
Date: |
| Address: |
City: |
| State: |
Zip Code: |
Country: |
| Phone: |
Fax: |
E-mail: |
| Type Of Business:
|
| Years In Business: |
Annual Sales in US $ |
| Estimated Monthly Purchase Volume US $ |
| Dun & Bradstreet (D&B) Number:
|
| Activities of Company
|
Contact Information
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.) |
|
