Account Application

Company name

Multi-line address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Phone

Fax

Email

Delivery Information

If the info below is the same as above, leave blank.

Delivery Address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Delivery Phone (leave blank if same as above)

Delivery Fax (leave blank if same as above)

Delivery Email (leave blank if same as above)

Accounts Payable Information

Accounts Payable Contact first name

Accounts Payable Contact last name

If the info below is the same as above, leave blank.

accounts_payable_address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Accounts Payable Phone

Accounts Payable Fax

Accounts Payable Email

Business Information

State of Incorporation

Year Established

FEIN Number

Dun & Bradstreet Number (D-U-N-S)

Sales Tax Exempt

Yes

No

Invoice Requirements

Company Officer(s)

Officer 1 First & Last Name

Officer 1 Title

Officer 2 First & Last Name

Officer 2 Title

Officer 3 First & Last Name

Officer 3 Title

Officer 4 First & Last Name

Officer 4 Title

Trade References

Please list a minimum of 3 suppliers

Reference #1

Company Name 1

Trade Reference 1 Address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Phone

Trade Reference 1 Email

Reference #2

Company Name 2

Trade Reference 2 Address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Phone

Email

Reference #3

Company Name 3

Trade Reference Address 3

Country/Region

Address

Address - line 2

City

Zip / Postal code

Phone

Email

Financial Information

Do not worry, your financial information is protected in our system with an additional layer of protection. Your info is secret and safe with BEST.

Bank Name

Account Number

Financial Information Address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Contact Name

Contact Phone

I/WE CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT. I/WE UNDERSTAND THAT ALL INVOICES SHALL BE PAID PROMPTLY WITHIN THIRTY (30) DAY TERMS AND, IN THE EVENT OF DEFAULT, I/WE AGREE TO PAY ANY COLLECTIONS CHARGES, ATTORNEY’S FEES AND COURT COSTS AS PERMITTED BY LAW.

Your Title

E-Signature, Type Your Name

E-Signature

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Today's Date

Month

Day

Year

Walker
Construction Co.

BEST Imaging Solutions Inc. 55 East Monroe Street Con F Lower Level Chicago, Illinois 60603

Accessibility Commitment

We are committed to ensuring that our website and services are accessible to everyone and strive to meet the highest accessibility standard. If you have any suggestions or encounter any accessibility barriers, please contact us at it@emailbest.com

Walker
Construction Co.

Contact Us

Accessibility Commitment

We are committed to ensuring that our website and services are accessible to everyone and strive to meet the highest accessibility standard. If you have any suggestions or encounter any accessibility barriers, please contact us at it@emailbest.com

BEST Imaging Solutions, Inc.

55 East Monroe Street Con F Lower Level Chicago, Illinois 60603

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