New Customer Info Form | Flotrans2021

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New Customer Information Form

Business Information

Flo Contact/Salesperson

Legal Company Name

Address

City

State

Zip Code

Phone Number

Tax ID Number

Type of Business

AP Contact

Fax Number

Type of Entity

In Business Since

Email

AP Contact Phone

Documents Needed for Invoicing:

Banking Information

Name of Bank:

Bank Address

Bank State

Phone

Contact Name

Bank City

Bank Zip Code

Fax

Email

Account(s):

Trade References

1

Company

Address

State (Reference 1)

Phone

Contact Name

City (Reference 1)

Zip Code (Reference 1)

Fax

Email

2

Company

Address

State (Reference 2)

Phone

Contact Name

City (Reference 2)

Zip Code (Reference 2)

Fax

Email

Applicant Printed Name

Title

Today's Date * required

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