Entity Identification
Print and complete this section and return with the signature of the person with authority to sign on behalf of the Entity. Or use our fill in form.
| Entity's Legal Name | |
| Entity's Doing-Business-As Name, if any | |
| Type of Entity (City, School Board, Non-profit Corporation, For Profit Corporation, LLC, etc.) | |
| Primary Location Street Address | |
| City | |
| State or Province | |
| Postal Code | |
| Mailing Street Address, if different | |
| City | |
| State or Province | |
| Postal Code | |
| Entity Legal Contact Name and Title | |
| Entity Legal Contact Email, Phone, and Legal Notice Address | |
| Entity Billing Contact Name and Title | |
| Entity Billing Contact Email, Phone, and Billing Address | |
| Entity Account Admin Name and Title | |
| Entity Account Admin Email and Phone | |
| Entity Signatory Name and Title | |
| By signing below, I warrant and represent that I have the authority to sign and bind the above listed Entity, pursuant to a policy adopted by Entity's governing board or body, to these Entity Terms, and to bind the staff, agents, and employees of Entity to these Entity Terms. | |
| Authorized Signature | |
| Date Signed |
