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New Client
BUSINESS NAME:
_______________________________________________
CONTACT
PERSON:______________________________________________
STREET
ADDRESS:_______________________________________________
CITY, STATE,
ZIP:_________________________________________________
TELEPHONE: ___________________ FAX:
____________________________
In business since: _________
Incorporated ___ Chain ____ Independent ____
BANK NAME:
_____________________________________________________
ADDRESS _________________________________________________________
ACCOUNT NUMBER _______________________________________________
If bank account is not listed under your
business name, please specify:
Account Name ________________________ Number __________________
PERSON RESPONSIBLE FOR PAYMENT
Name ______________________________
Title _____________________
If billing location is different from
client location, please specify:
Billing Address
________________________________________________________
City, State, Zip ____________________________________________
Billing Phone ( )__________________
FAX ( )________________________
TRADE REFERENCES
Credit has been extended by the
following companies/individuals to the business entry named
above. Please list at least three (3) trade references.
Name
Mailing
Address
Phone
1.________________________________________________________
2.________________________________________________________
3.________________________________________________________
I authorize Masiello Employment
Services, Inc. to make account inquiries at the above named bank/trade
references:
SIGNED
____________________________________________
DATE:
_____________________________________________
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