Know Your Customer Form
Email
*
example@example.com
Legal Company Name
*
Entity Group
*
C-Corp
S-Corp
LLC
Individual
Partnership
Other
Type of Business
*
Retail (own use)
Wholesale (sell to others)
Both
Business Description
*
Legal Business Street Address
*
Legal Business City, State, Zip Code
Main Telephone Number
*
Website URL
*
Number of Years in Business
*
Main Customer Contact (First AND Last Name)
*
Main Customer Contact Phone
*
Main Customer Contact Email
*
Has your company received a Civil Investigative Demand, or discontinued service due to a court order, injunction or temporary restraining order?
*
No
Yes
Please indicate whether you or calls that you dialed have been the subject of any formal written request from a government agency, subpoena, civil investigative demand, or other complaint:
*
No
Yes
Please indicate whether you or calls that you dialed have been the subject of any lawsuit filed by the Federal Trade Commission, or any other law enforcement action by any other state or federal agency:
*
No
Yes
Does your business involve telemarketing to solicit the purchase of goods, services, or charitable contributions?
*
No
Yes
Please describe the nature of the goods and services sold
*
Please indicate whether you use telephone calls to solicit the purchase of goods, services or charitable contributions that deliver pre-recorded messages:
*
No
Yes
Does your company initiate or transport robocalls/autodialed calls?
*
No
Yes
Upload A Copy of a Verifiable State-Issued ID or Passport
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload Proof of Address (Utility Bill, Lease, Bank Statement)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Signature
*
First Name, Last Name, Title
*
Date
*
-
Month
-
Day
Year
Date
Submit
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