Please fill out and return the following questionnaire to BIS via email fax to:

christa@bisonline.com, or Fax 866-855-5999

 

Company Information:

Company Name:

 

Office Hours:

 

Mailing Address:

 

City:

 

State:

 

Zip Code:

 

Phone Number:

 

Fax Number:

 

Office Contact:

 

Email:

 

Filing for County (s)

 

Phone Number:

 

 

Banking Information:

Bank  Name:

 

Routing Number: (Must be 9 digits)

 

Account Number:

 

Bank  Name:

 

Routing Number: (Must be 9 digits)

 

Account Number:

 

Bank  Name:

 

Routing Number: (Must be 9 digits)

 

Account Number:

 

Bank  Name:

 

Routing Number: (Must be 9 digits)

 

Account Number:

 

Bank  Name:

 

Routing Number: (Must be 9 digits)

 

Account Number:

 

Bank  Name:

 

Routing Number: (Must be 9 digits)

 

Account Number:

 

 

*Attach additional sheet with the above information if needed.