Membership Application Form

Business Membership Application

To apply for membership and a Net 30 business account, please complete all questions.We will report your Net 30 Term Trade line of credit to Equifax and Credit Safe on the last business day of the month. Allow 1-3 credit cycles for your tradeline to show up on your business credit report.
Visit our website for more details Lewis Enterprise Management Group
Business Name*
Business Address*
Suite Number
Business Phone Number*
City*
State*
Zip Code*
Legal Business Structure*
Annual Business Revenue
Taxpayer Identification Number (EIN)*
Company Industry*
Years in Business*
Number of Employees*
DUNS Number*
Website
You must be an Authorized Officer and Controlling Party of the business entity to submit this application. When opening an account, Federal regulations require that we obtain, verify, and record information for Beneficial Owners of an entity customer. For this application, Beneficial Owners are key individuals who directly or indirectly own the company, at a level of 25% or greater ownership, or are the trustee of a trust that has 25% or greater ownership. If a Trust owns 25% or greater, then enter the Trustee’s information as the owner.
Are you an Authorized Officer for this business?*

YesNo
Name*

First NameLast Name
Job Title*
E-mail Address*
All of the information above is accurate*

Yes
Signature

Clear
Signature Date

MonthDayYear
L.E.M.G Business Memberships
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1 Month Membership$50.00
Take advantage of this sale price and save $49! Available for a limited time only. Add a profit boost to your business!

3 Month Membership$99.00
Take advantage of this sale price and save $81! Available for a limited time only. Eligible to receive a $1,000 credit line increase.

Total $0.00
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Business Membership Application