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<br /> <br /> <br /> <br /> <br /> <br />Accounting Information Form <br /> <br /> <br />Please provide the following Accounting Information in the table below: <br /> <br /> <br />Customer Name <br />dl.company.2 <br />Tax Identification Number <br />dl.taxID.2 <br />Are you Tax Exempt? <br />dl.taxexemptyes.2 <br />If yes, please attach a copy of your Tax <br />Exemption Certificate <br /> <br />dl.Taxexemptdocument.2 <br />State Tax Exempt Number (if applicable) <br />dl.taxexemptnum.2 <br />Billing Contact Name <br />dl.billingcontactname.2 <br />Billing Contact Phone <br /> <br /> <br />dl.billingcontactphone.2 <br />Billing Contact Email <br />dl.billingcontactemail.2 <br />Billing Contact Fax <br />dl.billingcontactfax.2 <br />Are there any Special Invoicing needs? <br />dl.specialInvoicingneeds.2 <br />Special Invoicing Needs (if applicable) <br />dl.specialinvoicingcom.2 <br /> <br />DocuSign Envelope ID: 3DCCE44B-4891-47D9-BEB3-09B198AAC21B