Customer Account Application Form All information with a * is mandatory ...Please tell us what you are looking for... What services and/or product(s) are you interested in? ...Please tell us about your company... Company Name Company Website Have you ever done business or have existing accounts with Enhanced Logistics 21 or any of it's affiliates? Yes No Type of Business (Click all that apply) End customer Distributor Import/Export Processor Packing House Trader Others Company Type Proprietorship Partnership Limited Partnership Corporation Limited Liability Non-Profit Foundation date (Year) Number of Employees Annual Revenues in $ Please share with us a reference you work with: Business name Contact person Title Mobile number Email ...Please share with us your contact information... Company Address Postal Code City Country Main Contact Person Title Mobile number Email Second Contact Person Title Mobile number Email ...Please share with us who your bank is... Bank name Postal code City Country ...Anything else you want to share with us?... Send
