MY|FURNISHWEB

Supporting Documents (Upload as many as necessary)

* denotes a required field

Trade Name

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Legal Name

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Street Address 1

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Street Address 2

City

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County

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State

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Zip

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Country

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Corporation

Incorporated

Tax ID

Partnership

Sole Proprietorship

Resale :

Yes

No

( Resale Card must be attached. )

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Phone

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Fax

Contact Name (1)

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Contact Email (1)

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Contact Name (2)

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Contact Email (2)

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Website URL

Dun & Bradstreet

Total Annual Sales

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AP Contact

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Total Employees

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CONTACT INFORMATION:

(Can add multiple in each row, use a semi colon to separate ";")

Preferred Billing Method

US Postal Service

Email

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Main Email Contact

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Email Invoices To

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Email Statements To

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Email Order Confirmations To

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Email Tracking Numbers To

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Email New Products & Pricing Updates To

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How did you find out about us?

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Will be resold by me in the form of tangible property; provided, however, that in the event any of the property is used for any purpose other than retention, demonstration, or display while holding it for sale in the regular course of business. It is understood that I am required by the sales and use tax law to report and pay for the tax measured by the purchase price of such property.

Signature

Title

Date Signed

BUSINESS INFORMATION

CONTACT INFORMATION: