 |
|
|
|
|
|
|
Company Name
|
|
|
|
Street Address
|
|
|
|
City, State & Zip
|
|
|
|
Telephone Number
|
|
|
|
Fax Number
|
|
|
|
Reseller Tax ID#
|
|
|
|
Type of Organization
|
|
|
|
Parent Company - City/State
|
|
|
|
Business Catagory
|
|
|
|
Annual Sales (Approx)
|
|
|
|
Contact: Purchasing
|
|
|
|
Contact: Finance
|
|
|
|
Bank
|
|
|
|
Bank Street Address
|
|
|
|
Bank City, State & Zip
|
|
|
|
Phone / Contact Name
|
|
|
|
Account
|
|
|
|
Credit References
|
|
|
