New Customer Application

MarathonLS is here to provide solutions that keep you focused on what matters most: your groundbreaking work.

New Customer Application

Business Contact Information

Title:(Required)

Date Business Commenced

Company Name:(Required)

Phone(Required)

Email(Required)

EIN#(Required)

Registered Company Address:(Required)

W9 Form Attached

Tax Exempt/Form Attached

W-9 File(Required)

Accepted file types: pdf, jpg, png, Max. file size: 512 MB.

Tax Exempt Form File(Required)

Accepted file types: pdf, docx, doc, rtf, jpg, Max. file size: 512 MB.

Business and Credit Information

City, State, Zip Code:

Bank Name:

How Long at Current Address:

Phone(Required)

Fax:

Account Number:

Type of Account:

Savings

Checking

Other

Payment Terms:

Company Invoice/Bill to Information

Invoice/Billing Email:(Required)

Accounts Payable Contact:(Required)

Phone

Fax:

Invoice Billing Address:(Required)

City, State:(Required)

Postal Code:(Required)

Attention:

Preference to Receive Invoice by:

Other

If Other, Please Provide Details:

Business/Trade References

Company Name:

Phone

Company Address:

Fax:

Company Name:

Phone

Company Address:

Fax:

Agreement

1. Payment terms are net 30 days.

2. Disputes arising from invoices must be made within seven working days of receipt.

3. By submitting this application, you authorize MarathonLS to make inquiries into the banking andbusiness/trade references that you have supplied.

4. You certify that the above information is accurate and correct to the best of your knowledge.

5. You agree to the attached Terms & Conditions of Service as outlined.

Signatures

Signature 1(Required)

Signature 2

Name and Title 1:(Required)

Name and Title 2:

Date 1(Required)

Date 2

New Customer Application