Inferno Ads Due Diligence

COMPANY INFORMATION
Signing up As Advertiser or Affiliate
Your Company Name
Individual Submitting
Legal Business Name
Legal Entity Type
Length of Time in Business
Physical Address

Full Physical Address

Street Address Line 2

City

Postal / Zip Code
Date & State of Incorporation
Full Mailing Address
Phone Number
Email
example@example.com
Website/Social Media
Preferred Language
Time Zone
Currency
CORPORATE OFFICERS/MANAGEMENT - PLEASE INCLUDE A BRIEF SUMMARY OF QUALIFICATIONS AND
Owner(s)
President/CEO
Agency Manager
Marketing Representative
Primary Contact & Method
Tax ID /VAT(Company) or SSN(Individual)
Charter Number
Legal Form of Ownership
List all Owners, Partners or Officers and their Percent of Ownership.
Bank References & Contact
GENERAL INFORMATION
Partners Only* If applying as an individual Partner - please provide/attach a copy of your Government Issued photo Identification. If you are a Company please upload a W9 or W8 form with Company EIN

Cancelof
Payment Terms Requested
Payment Method
Customer Type
Tax Reg No.
Please 1 of 3 three trade references, including name, company name, email address and phone number.
Please list 2 of 3 three trade references, including name, company name, email address and phone number.
Please list 3 of 3 three trade references, including name, company name, email address and phone number.
Name

First NameLast Name
Signature

Clear
Date

MonthDayYear
Date
Authorization to Release Information

My signature below is authorization for you to release information regarding my credit, banking and/or ratings to Inferno Ads, LLC. relative to my application to become an approved advertising partner Reproduction of this authorization is to be considered as valid as the original.
Signed

Clear
Date

MonthDayYear
Date
Printed Name and Title
Company name and address
Company: Contact: Telephone #: Fax #: Email address
Company
Contact
Fax #
Email address
example@example.com
This is to certify that
(Company/Bank Name) concerning the accounts listed below to:
Please forward the information requested by Inferno
Ads, LLC to: Approval & Accounting Department Via email to: accounting@infernoads.com

is authorized to release information ,
Name on Account
Account #
Authorized Signature

Clear
Date

MonthDayYear
Date
Printed Name and Title
Phone #
Please accept this authorization to release information on the above listed accounts to Inferno Ads, LLCI (we) understand that this information will be kept in strictest confidence between your organization and Inferno Ads, LLC Checking AccountSavings Account Bank Use Only Loan Account #:
Provided by
Date

MonthDayYear
Date
Should be Empty:

COMPANY INFORMATION

CORPORATE OFFICERS/MANAGEMENT - PLEASE INCLUDE A BRIEF SUMMARY OF QUALIFICATIONS AND

GENERAL INFORMATION