New Account Form

The USA Patriot Act requires that we implement an Anti-Money Laundering Program. As part of our compliance requirement, the US Treasury mandates that we document and verify certain customer and supplier information.

We kindly request that you complete the form below.

Please be assured that all information will remain strictly confidential.

Thank you for your prompt attention to this matter.

Thank you for submitting your form!

We appreciate your interest and will review your information as soon as possible.

Our team is dedicated to providing excellent customer service, and we will do our best to respond promptly.

Company Name *

Main Contact -First Name *

Last Name *

Email *

Phone *

Resale Certificate ID *

TAX ID Number *

Business Address *

City *

Postal code *

Country *

Have you established an Anti Money Laundering program or in the process of establishing one according to USA Patriot Act? *

Yes No

Compliance Officer *

I, undersigned, confirm that the above stated information is true and correct and undertake to provide any changes to the aforesaid details, and I have provided/will provide (or disclosed, if applicable) required documentation.

Digital Signature *

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New Account Form

The USA Patriot Act requires that we implement an Anti-Money Laundering Program. As part of our compliance requirement, the US Treasury mandates that we document and verify certain customer and supplier information.

We kindly request that you complete the form below.

Please be assured that all information will remain strictly confidential.

Thank you for your prompt attention to this matter.