Business Legal Name *
Trade Name (if any)
Legal Address 1 *
Legal Address 2
City *
State *
Postal Code *
Country *
Is shipping address different from legal address? YesNo
Address 1
Address 2
City
State
Postal Code
Country
Phone *
Website
Federal Tax ID# or SS# *
Tax Exempt (please attach your Tax Exempt Letter if yes) YesNo
If yes, please send your Tax Exempt Letter by email to sales@crossroadpublishing.com
Account Type * Choose onePersonal AccountReseller AccountInstitutional AccountAuthor Account
Others – Please Explain
Name *
Email *
Title / Position
Is Account Payable contact different? YesNo
Name
Email
