atacirShconficienct D&B Business Information Form Welcome to D&B. The information you provide will be used as a basis for credit. insurance, marketing and other business decisions. A D&B business analyst may contact you upon receipt of this completed form to clarify some of the information. 1 - GENERAL INFORMATION Business Name DBA D Date the Business staled Street Address City. State Zip Code Number of full & part-time employees. including owners Mailing Address Names of Owners/Officers: 1 Tide: Work Phone: 2. This: Far 3. The: 2 - OPERATIONS - A DESCRIPTION OF THE BUSINESS FUNCTION Describe what the business does: Do you offer your product or service on CASH or CREDIT If you offer credit • please specify billing terms: Sales territory is: LOCAL NATIONAL REGIONAL INTERNATI The customers of this business are THE GENERAL PUBLIC COMMERCIAL ACCOUNTS OTHER primarily: 3 - HISTORY OF THE BUSINESS - HOW THE BUSINESS GOT STARTED The legal structure is: Proprietorship Partnership Corporation Other Is trade style registered, YES NO The dollar amount 3 used to start this business was If trade style is registered City/Town Registered This money Loans from S came from: the owners Date incorporated State where incorporated Savings S 'Other S Date registered Please specify: 4 - FINANCE -A USTING OF THE BUSINESS ASSETS AND LIABILITIES If this information has been prepared by your accountant, please attach a copy of the financial statement to this form. Date of the figures below: / / The month the fiscal year ends: EFTA_R1_0 1173952 EFTA02302943