NEW CUSTOMER APPLICATION FORM
PLEASE ANSWER ALL FIELDS CLEARLY AND LEGIBLY
Type of Customer:
( ) Individual ( ) Partnership ( ) Proprietorship ( ) Corporation ( ) LLC
Name:
d/b/a:
Federal EIN#:
DUNS#:
State Resale:
Years in Business:
Principle Address:
Phone: (
)
Fax: (
)
Email:
Type of Business:
No. of Employees:
Annual Sales:
Principal(s) of Customer:
1. Name:
SSN (EIN if Company):
Years with Firm:
Driver’s License # (if applicable):
Address:
Phone: (
)
Fax: (
)
Email:
Business Credit References:
1. Company Name:
Address:
Phone: (
)
Fax: (
)
Contact Name:
2. Company Name:
Address:
Phone: (
)
Fax: (
)
Contact Name:
I/We, the undersigned applicant(s) (the “Customer”), certify that all of the information supplied on this New Customer
Application Form is true and accurate, and request to open an account with GSMCity, Inc. Furthermore, that by
completing the credit information section on this form, I/we consent and authorize GSMCity, Inc. at any time to obtain
from any credit reporting agency or any other source, such information that GSMCity, Inc. deems to be appropriate to
the credit hereby applied for. I/we acknowledge that I/we is/are jointly and severally and liable for all purchases
and/or services supplied to Customer by GSMCity, Inc. under my/our personal name(s), trade name(s) or corporate
name(s) in which I/we are partner(s) director(s) or shareholder(s).
CUSTOMER(S):
By:
Print Name:
___Title:
New Customer Application Form
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