Proof of Existence Form Rev 091014

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Proof of Existence Form Rev 091014 Powered By Docstoc
					                                                  Keystone Scent Company
                                                  100 West Road, Suite 300
                                                 Baltimore, MD 21204-2370
                                      410-832-7111 ● 800-784-9771 ● Fax: 410-832-7073

                            PROOF OF EXISTENCE FORM
Instructions: Complete and return this form, along with a copy of your sales and use tax
              license, or other business license, by fax, postal mail or by e-mail to
              keystone@k29.com. Please be clear and legible so that we can process your
              request in a timely fashion.


Business Name: ______________________________________________________________

Authorized Contact(s): _________________________________________________________

Federal Identification Number: ___________________________________________________

Address: ____________________________________________________________________

City: ________________________ State: ___________________ Zip Code: ______________

Telephone Number(s): ______________________________ Fax #: _____________________

Email Address: ______________________________________________________________

Website Address: _____________________________________________________________

Type of Business (please check one):

Retailer_________             Wholesaler_________        Distributor_________

Number of years in business: ________        Approximate number of customers: _________

Brief description of your business:




                       NOTE: THIS IS NOT A CREDIT APPLICATION


For Office Use Only
Approved _______ Denied _______ Form Incomplete _______ Missing business license _______
Reason for denial______________________________________________________________Int_____________
                                                                                     Revised 10/14/09

				
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