It may be helpful to require a company that may seem suspicious to complete a disclosure before accepting work from them, or just as a standard practice. This is just a suggestion, it may save some grief down the road.
Company/Entity Legal Name: ___________________________________________________________
State of Incorporation: _________________________ EIN No.: __________________________________
How Long has your Company been in Business? _______
Is your company based in the United States and are all operations performed in the United States? _______
If NO, please list the country/countries in which you have operations:
________________________________
________________________________
________________________________
If your operations are outside of the United States, do you have physical locations within the United States? _______
Street address of main U.S. business operations (no PO Box):
______________________________________________________
______________________________________________________
Billing Contact Name: ____________________________ Phone No.: ______________ Email: _____________________
Billing Contact Address IF different from above:
______________________________________________________
______________________________________________________
Please provide two credit references located in the United States (if credit references are not provided, or you do not have a physical location within the United Sates, pre-payment of all orders will be required until we can establish a good payment history before orders are released, no exceptions).
_____________________________________________________________________ Phone: ____________________
Name/Address
_____________________________________________________________________ Phone: ____________________
Name/Address
PLEASE NOTE: The information provided above will be verified prior to accepting work orders. If any of the information provided cannot be verified or is incorrect, we will not be able to do business with you. Thank you for your cooperation.
Completed by: ____________________________________, Company: _______________________, Title: _____________
(please print)
Date: ___________________ Signature: ___________________________________
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