Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Company/Organization Information
Legal Name ____________________________________________________________________
Trade Name ____________________________________________________________________
Division _______________________________
Address _______________________________________________________________________
City ________________________
State _____________________
Zip ______________
Email ________________________________________________________________________
Address is:
Branch
Head Office
Regional Office
National Headquarters
Parent Company
Address _______________________________________________________________________
City ________________________
State _____________________
Zip ______________
Email ________________________________________________________________________
Proprietorship
Corporation
Partnership
LLC
Other
State _____________________
Zip ______________
Partnership: Complete the following information for each partner (attach a list if necessary)
Name _________________________________________________________________________
Address _______________________________________________________________________
City ________________________
State _____________________
Zip ______________
Principals/Corporate Officers
President, Vice President, Secretary, Treasurer, Chief Financial Officer
Name
Title
Telephone Number
Name
Title
Telephone Number
Name
Title
Telephone Number
Name
Title
Telephone Number
Name
Title
Telephone Number
Bank Details
Bank Name ____________________________________________________________________
Bank Officer ___________________________________________________________________
Branch & Address _______________________________________________________________
Address _______________________________________________________________________
City ________________________
State _____________________
Zip ______________
Email ________________________________________________________________________
Yes
No
Hotel References
Name _______________________________________________
Address _______________________________________________________________________
City ________________________
State _____________________
Zip ______________
Date of stay
________________________
Email ________________________________________________________________________
Name _______________________________________________
Address _______________________________________________________________________
City ________________________
State _____________________
Zip ______________
Date of stay
________________________
Email ________________________________________________________________________
Name _______________________________________________
Address _______________________________________________________________________
City ________________________
State _____________________
Zip ______________
Date of stay
________________________
Email ________________________________________________________________________
Name _______________________________________________
Address _______________________________________________________________________
City ________________________
State _____________________
Zip ______________
Date of stay
________________________
Email ________________________________________________________________________
Telephone
Yes
No
Yes
No
Signed ________________________________________________________________________
Address _______________________________________________________________________
City ________________________
State _____________________
Zip ______________
Email __________________________________
Date
________________________
I _____________________________________________
charge my
(Name as it appears on the credit card)
credit card the entire outstanding balance in the event that _______________________________
(Company Name)
Account reaches 30 days past due.
Visa
Master
American Express
Date ___________________
Date ___________________
**PLEASE ATTACH A COPY OF THE FRONT AND BACK OF THE CREDIT CARD
Date ______________
Comments: ____________________________________________________________________
Direct Bill approved by_____________________________________
Date ______________
GM Signature __________________________________________________________________
Renewal Date _________________________________________ Credit Limit ______________
Direct Bill account number (AR #) _______________________