Please complete this two page form as follows and email the completed form to us at firstname.lastname@example.org. You may also fax to us at 770-852-6879.
- Check the box that applies to your company; either individual, corporation/LLC, partnership or sole proprietorship
- Insert your Federal EIN number on the line provided. If an individual please use your Social Security Number here
- Insert your company name on the line that begins “Know All Men by these Presents that …….”
- Insert the name of the State under whose laws you are doing business in the space provided
- Show your full physical address (not PO Box) on the lines provided
Now go to PAGE TWO
- If a corporation or LLC have an officer of the corporation sign in the space provided
- If a partnership please have one of the partners sign and please include a copy of the partnership agreement showing that this person has authority to sign
- If an individual or sole proprietorship that individual or proprietor should sign
- Indicate the job title or capacity of the person who signed the form
- Indicate the date the form was signed
- Have a witness sign the form – this does not need to be notarized
Form is now COMPLETE. Please email or fax to us.
See below for images of the form showing the areas that must be completed: