DDS DDS Account Set-up Form  

Premium Service Guaranteed Service
DDS INFORMATION
Date:* MM/DD/YYYY  
DDS ID:*  
DDS Account Rep: Rep Phone:
AGENCY INFORMATION
Company Name:*
Street Address:*  
City:*
* Zip:* *
Main Phone:* Company Website:
USER INFORMATION
User Name:* Title:  
Phone:* Fax:* Email:
Street Address: (If different from Company)
City:
Zip:
ACCOUNTING INFORMATION
Contact: Title:  
Phone: Fax: Email:
Street Address: (If different from Company)
City:
Zip:
Should invoices be forwarded to user first for approval?  
NOTES

* Required