AR ACCOUNT VERIFICATION
Dealer Name
Account #
DUNS #
Legal Form of Business
Please select...
LLC
Sole Proprietorship
C Corporation
S Corporation
Partnership
Federal Tax Identification Number
State Resale Tax Identification Number
Billing Address
Street Address Line 1
Street Address Line 2
City
State
Zip Code
Phone Number
Company Ownership Information
Owner/President/Executive
Full Name
Job Title
Ownership Share Percentage
Direct Phone Number
Owner 2
Full Name
Job Title
Ownership Share Percentage
Direct Phone Number
Accounts Payable Contact Information
Full Name
Phone Number
Email Address
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