Prospective Partner Organization Form

Organization Fact Sheet

The use of the following form is intended to help Arbor Associates professionals meet their obligations. Please complete accurately. In addition to this form, a separate "Program Fact Sheet" must be submitted and approved for each location in which you'd like to use Arbor Associates' services. Please contact us at 888-272-6767 with questions. Thank you!

* Indicates required field

Name of Organization (Partner) *

Phone Number *

Website *

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

How did you hear about Arbor Associates? *

DBA/Other Legal Name(s)? *

List any previous business addresses *

Contact 1 *

First

Last

Contact 1 Title *

Contact 1 Email *

Contact 1 Phone *

Contact 2 *

First

Last

Contact 2 Title *

Contact 2 Email *

Contact 2 Phone *

Contact 3 *

First

Last

Contact 3 Title *

Contact 3 Email *

Contact 2 Phone *

Number of Years in Business *

Tax ID number *

Choose - Business Status *

Choose - Business Classification *

Do you require prior authorization for services? *

If Authorization is required, please explain *

Accounts Payable Contact *

First

Last

AP Title *

Billing Address (if different from above) *

Line 1

Line 2

City

State

Zip Code

Country

AP Email *

AP Phone *

Fax *

Credit Information

Name of Bank *

Account Number *

Contact at Bank *

Phone *

List 2 Current Business References

Business Reference 1 *

Business Reference 2 *

Privacy policy. This privacy policy sets out how Arbor Associates uses and protects any information that you give Arbor Associates when you use this digital form. Arbor Associates is committed to ensuring that your privacy is protected. Should we ask you to provide certain information by which you can be identified when using this digital form, then you can be assured that it will only be used in accordance with this privacy statement. *Security on our intranet is treated seriously. We undertake security steps, including SSL technology, to protect customer account information and data transmissions.

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