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