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- Memory Modules + Lifetime Warranty - P.O. Box 8638, Rowland Heights, CA 91748, USA Phone: (909) 556-3708 e-mail: email@unitedmemory.com |
New Account Application
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Corporate Name: |
Phone: |
Fax: |
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Other AKA Name(s): |
Website: |
E-mail: |
| Bill To: | Ship To: |
| Street: | Street: |
| City: | State: | Zip: | City: | State: | Zip: |
| [ ]Corp., [ ]S. Corp., [ ]Partnership, [ ]Sole Owner, [ ]LLC, [ ]Others | Year Started: | No. of Employees: |
| Annual Sales: | Federal Tax I.D. #: | State Resale Permit #:(Copy attached) |
| Sole Owner/Partners/Corporate Officer(s) Information: |
| Name 1: | Title: | Social Security Number: |
| Home Address: | City: | State: | Zip: |
| Driver's License # (State): | Home Phone: | Signature: |
| Name 2: | Title: | Social Security Number: |
| Home Address: | City: | State: | Zip: |
| Driver's License # (State): | Home Phone: | Signature: |
| Authorized Purchasing Agent(s): | Phone: | Account Payable Manager: | Phone: |
| Bank Information: (Checking Account of Your Payment Bank) |
| Bank Name: | Branch: | Contact Officer: |
| Bank Address: | City: | State: | Zip: |
| Account # (Void check attached): | Open Date: | Bank Phone: | Bank Fax: |
| Print Your Name: | Your Title: | Your Signature: | Date: |
| Account Status: (United Technology Internal Use Only) |