CUSTOMER APPLICATION FORM CUSTOMER APPLICATION FORM Customer Information Business Name * Store Address Street Address * City * State * Zip Code * Contact Information First Name * Last Name Email * Phone * Website/URL Company / Store Information COMPANY / Store Name ( as shown on Federal Tax Return) * TAX ID NUMBER (F-EIN OR Business License) * Organiztion Type * Corporation LLC Individual / Sole Proprietor Partnership/Limited Partnership Joint Venture Non-Profit * I, (Customer Name Above), hereby authorize OUD N MUSK LLC to collect, store, and maintain the business and banking information provided for the purpose of establishing and managing a business-to-business account. I understand that this information will be kept securely on file and used solely for account verification, internal records, and ongoing business relationship management. I certify that I am an authorized representative of the business and that I have the authority to provide the information submitted. I acknowledge that the information provided is accurate and complete to the best of my knowledge. I understand that this authorization will remain in effect unless and until I provide written notice of revocation to OUD N MUSK LLC. Submit If you are human, leave this field blank.
