Screening & Selection Services from Seal-Tight Security, Inc.

Sales Order Form

Sales Order Form is not valid without Screening Services Agreement completed and attached

Please print out, complete and fax this form to 847. 640. 1380.
If you have questions contact a sales representative at: 847. 640. 2210.

Legal Name of Business _______________________________________________________________

Physical Address _____________________________________________________________________
CityStateZip Code

Mailing Address _____________________________________________________________________
CityStateZip Code

Primary Contact_____________________________________________________________________
FirstLastTitle

Phone # __________________ Fax # ________________ E-mail _______________________________

Secondary Contact ____________________________________________________________________
FirstLastTitle

Phone # __________________ Fax # ________________ E-mail _______________________________

Identify two officers (or owners) of your business, or if your company is traded on a recognized stock exchange, please provide the symbol and exchange.

________________________________________________________________________
NameTitlePhone

________________________________________________________________________
NameTitlePhone

________________________________________________
SymbolExchange

Please describe your company's business ____________________________________________________

For what purpose are you requesting access to these reports? ______________________________________

List the approximate number of employees _________

How long has your company been in business? ______

If your company is exempt, please provide your tax ID number and a copy of your exemption certificate.
Tax ID # __________________ 

Billing Address (if different than physical location)

__________________________________________________________________________________
StreetCityStateZip Code

Billing Contact ______________________________________________________________________
FirstLastTitle

Phone # __________________ Fax # ________________ E-mail _______________________________

Set up Fees $______________________________________________________________________________________________

Sales Order is not valid without Screening Services Agreement completed and attached.

( ) Client ( ) Prospect ( ) Stand alone

Customer Number________________ Parent Number __________________ Billing Number ____________

Site Visit performed by ___________________________________________________________________

NameTitleDate

Ph: 847. 640. 2210