Fillable Customer Profile 2605 Phoenix Drive, Greensboro, NC 27406

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Customer Profile 2605 Phoenix Drive, Greensboro, NC 27406

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P. O. Box 16963, Greensboro, NC 27416
Customer Profile 2605 Phoenix Drive, Greensboro, NC 27406
336-275-4444 336-544-2088 FAX
Company name:
DBA (if different):
Contact person : E-mail Address:
Company Website Address:
Mailing Address :
City: State : Zip :
Physical Location if different:
Phone :
Fax :
Federal tax ID or Social Security number:
Type of business:
Date business established:
Please check one:
• CORPORATION
State of incorporation Date incorporated:
Names and titles of your three chief corporate officers:
• PARTNERSHIP
Names & addresses of the partners:
• SOLE PROPRIETORSHIP
Name of owner:
Bank Name:
Bank Address:
Type Account (please list account numbers)
Savings:
Checking:
Are you Sales Tax Exempt: (If YES, fill Out attached Certificate and return)
Do you plan to resale the Merchandise? (if YES, don’t forget to fill out attached Certificate)
If yes, will the merchandise be sold from a store front? Please Answer YES or NO
Authorized Purchasers:
Purchase Order Required?
AUTHORIZED SIGNATURE: PRINTED NAME:
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Customer Profile 2605 Phoenix Drive, Greensboro, NC 27406

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Completed 5 February 2021

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