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 |