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 |