New Customer Questionnaire Form

BBB A+ MIDCOM 40 Years In Business

Toll-Free (800) 643-2664

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New Customer Questionnaire - Welcome to MIDCOM

MIDCOM Data Technologies

New Customer Questionnaire - Welcome to MIDCOM

Company Name:

TAX STATUS: Are You Tax Exempt?: If so, please attach form below.

Yes

No

Attach Tax Exempt Form

Upload File Here >>

VENDOR PORTAL: Does your company use a vendor pay portal requiring registration?

Yes

No

Free Text

ACCOUNT SETUP: Please provide account setup information to accounting@midcomdata.com

PURCHASE ORDERS: Are purchase orders required to process payment?

Yes

No

Free Text

AP CONTACT INFORMATON

Name:

Direct Phone:

Email Address:

Free Text

DOCUMENTATION REQUIREMENTS

Do you require a MIDCOM W9 form?

Yes

No

Free Text

Download MIDCOM W9 here >>

Do you require a Vendor Registration form?

Yes

No

Attach Vendor Form:

Upload File Here >>

Free Text

Or, please email vendor packet to accounting@midcomdata.com

Do you require a Certificate of Insurance for T&M onsite service or annual service contracts?

Yes

No

Thank you for submitting the New Customer Questionnaire

Please call (800) 643-2664 or email accounting@midcomdata.com with any questions.

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Call Us (800) 634-2664

About Us

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FAST Onsite Printer Repair

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MIDCOM Service Group

National Headquarters
2625 E. Oakley Park Rd.

Suite 125
Commerce TWP, MI 48390-1667
Toll-Free (877) 996-3625

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