Professional Application Form - ProfEdge Corporate Solutions

Business Aplication

Date:

Legal Business Name:	DBA (Doing Business As):
BILL TO: Street Address or PO Box: City: State: Zip:
SHIP TO: Street Address or same as above City: State: Zip:
Business Phone:	Fax Number:
Years in Business:	E-Mail Address:
Website Address:	Federal Tax ID Number:
Purchaser Contact Name: E-Mail Address:	Accounting/Payables Contact Name: E-Mail Address:
Kind of Business: Sole Proprietor Partnership LLC LLP S-Corp C-Corp Private C-Corp
Where were you referred by someone?
Lift Gate Needed: Yes No	Building: Private Own Rent
Have your principals ever filed bankruptcy? Yes No	Are you subject to state sales tax? Yes No
Business Hours for Shipping Purposes: Monday-Friday Saturday-Hours Sunday-Hours

QUESTIONS FOR CORPORATIONS
Years Incorporated:	In the State of:
President: Phone Number:	Vice President: Phone Number:

QUESTIONS FOR SOLE PROPRIETORSHIPS & PARTNERSHIPS
Owner/Partner:	Home Address (City, State, Zip):
Phone Number:	Cell Number:
Owner/Partner:	Phone Number:

SHIPPING QUESTIONS
Do you have a commercial dock? Yes No	Do you have a forklift? Yes No
Is your shipping location considered limited access? Yes No	Do you need a lift gate? Yes No