RROI PROSPECTIVE CUSTOMER INFORMATION FORM

Our company's legal name is*
Our company's operating name is (i.e., 'doing business as')*
Our company's physical address is*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Our company's website address is
The state/province and country in which our company is incorporated/organized is*
Is your company a parent or a subsidiary?*
- Yes
- No
If so, which companies are your subsidiaries or which company is your parent?
Our general type of business is*
I agree that my electronic signature is the legally binding equivalent to my handwritten signature, and that my electronic signature has the same validity and meaning as my handwritten signature. I agree that I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.
Electronic Signature*
Your Name*
Your Title*
Consent*
I understand this data will not be retained for future access*
This data will be immediately removed from the website upon submission. No customer, client, or employee information will be retained for access in the future.
Name
This field is for validation purposes and should be left unchanged.