Customer Onboarding

Customer Information Form

Business Name: *

Business Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Business Phone: *

Business Email: *

Business Website / URL: *

Legal Structure: *

Business Tax ID Number: (EIN)

Does your business require a PO# for invoicing? *

Primary Contact Name: *

First

Last

Primary Contact Title: *

Primary Contact Phone: *

Primary Contact Email: *

Accounting Contact Name:

First

Last

Accounting Contact Title:

Accounting Contact Phone:

Accounting Contact Email:

Other Contact Name:

First

Last

Other Contact Title:

Other Contact Phone:

Other Contact Email:

Additional Notes or Comments:

Customer Signature: *

Clear Signature

I authorize the verification of the information provided on this form as to my credit and employment.

Date:

Audio Visual Resource & Services Provider

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