Captiva Solutions LTP Account Application Form

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Unique selling point 2

Unique selling point 3

Unique selling point 4

Business info

Billing info

Shipping info

Business info

Company Name

DBA (If applicable)

Type of Account Application

Do you require the use of Purchase Orders?

Provide Email Address of the Order Contact(s)

Are you tax exempt?

Type of Business

Are you entitled to GSA Pricing?

What type of training do you provide?

Billing info

Accounts Payable Main Contact

Phone Number

Company Name (if different from above)

Email Address of AP Contact

Physical Address (City, State and Zip)

Country

Email Address for electronic Invoices

Shipping info

Main Contact

Phone Number

Company Name (if different from above)

Email Address

Physical Address (City, State and Zip)

Country

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