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Representative of ___________________________________
IT______________ Chemical Industry
Electronic Industry Trading House Hardwares
Equipment Manufacturing Tooling/Fabrication Consultant/Services (circle one)
Mfg of __________________ Construction Others
Company Website :
Company Name
Division Subsidiary of
Home Office Street Address
City State Zip Country
Telephone No. Key Contact
Fax No. E-mail
Address
City State Zip Country
Telephone A/R Person to Contact
Fax A/R Contact e-mail
Bank Name Checking or Savings Account
Bank Transit Number (ABA#) Swift Code Reference/Roll #
Bank Account Number Currency
Bank Address
NO
YES If yes, please specify:
NO
YES If yes, please specify:
Title of Project Status In progress Year Completed :
Title of Project Status In progress Year Completed :
Title of Project Status In progress Year Completed :