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:

1. ________________________________

2. ________________________________

1. ________________________________

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).

1. ­­­­­­­­­­­­­­­­­­­­_____________________________________________________________________ Phone: ____________________

   Name/Address

2. _____________________________________________________________________ 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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