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New Customer Questionnaire

Company Form

The purpose of this questionnaire is to provide all necessary information that will enable Jelvix to check and prepare all legal, financial, and project documents.

The questionnaire has to be filled in and submitted in English ONLY

CUSTOMER’S GENERAL INFORMATION

Company Name:

Please enter your Company Name

(as it appears on the Certificate of Incorporation or equivalent documents)

Company is:

Private

Public

Government-owned

REGISTRATION DETAILS

Number: Please enter your Number

Date:

VAT Number: Please enter your VAT Number

Main business activities:

Number of years in operation:

Number of employees:

Number and location of branches (including representative offices):

REGISTERED ADDRESS

Number and street: Please enter your Number and street

City: Please enter your City

State (for US): Please enter your State

Postal Code: Please enter your Postal Code

Please enter your Country

PHYSICAL ADDRESS

Physical Address is the same as Registered Address.

Number and street:

City:

State (for US):

Postal Code:

CONTACT DETAILS

Phone: Please enter your Phone

Email: Please enter valid email address

Mobile:

Skype ID:

Fax:

Web Address:

REPRESENTATIVE’S (SIGNATORIES) INFORMATION

#1

Name: Please enter valid Name

Position: Please enter valid Position

Date of Birth: Please enter your Date of Birth

Contact information (phone/email/etc): Please enter valid Contact information

FINANCIAL INFORMATION

Preferable payment currency:

USD

Euro

Pounds

Other

REQUESTED SERVICES

Consulting

Project management

Development

Dedicated Development Team

Technical Support

Specification

UI/UX

Other

Please choose any services

DOCUMENTS

Please make sure that you enclose the following documents and information and check the boxes accordingly:

Certificate of Incorporation or Articles of Association

Memorandum of Association (or similar)

Company register extract

Appointment of Director (or similar)

Information on the legal address of the registered office

The minutes or the resolution of the management board (director) / or power of attorney, or other legal authorization documents in respect of the person who is authorized to execute the Master Agreement on behalf of the company

Please choose any Documents

Attach documents

OTHER INFORMATION

Please feel free to provide us with any additional information that you believe might be helpful for our cooperation: Please enter from 25 to 500 characters

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Thank you for your application!

We will contact you within one business day.