Website Design Questionnaire

PPE Intake Worksheet

Submitted By*
First Last
Date Submitted*
Date Format: MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
WhatsApp Number
Skype ID
Email*
Relationship to Buyer*
Product Type*
Brand*
Quantity*
Up To Price Per Box*
Transaction Type*
How Buyer Will Transact This Purchase*
- Irrevocable Letter of Credit
- Cage Code
- Escrow
- MT199
- MT799
- BCL / Bank Verification @ A2A
NOTES
Upload LOI - LOA - ICPO - Misc.*
Drop files here or

Accepted file types: pdf, doc, docx, .
Buyer Info
Buyer's Company Name*
Registration Number / CIPC/ EIN*
Tax ID / SARS / VAT / TIN / RUC*
Name*
First Last
Buyer's Title*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Buyers WhatsApp Number
Buyers Skype ID
Fax
Buyer Email*
Buyer Website
Buyer Attorney Information
Attorney's Name*
First Last
Attorney's Address*
Street Address Address Line 2 City State ZIP Code
Attorney Phone Number*
Attorney's Email*
Attorney's Website
Buyer Mandate
Buyer Mandate*
First Last
Buyer Mandate Address*
Street Address Address Line 2 City State ZIP Code
Buyer Mandate Phone*
Buyer Mandate Email*
Facilitator 1
Participate 1
First Last
Facilitator 1 Relationship
Facilitator 1 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Facilitator 1 Phone
Facilitator 1 Email
Facilitator 2
Facilitator 2 Name
First Last
Facilitator 2 Relationship
Facilitator 2 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Facilitator 2 Phone
Facilitator 2 Email
Facilitator 3
Facilitator 3 Name
First Last
Facilitator 3 Relationship
Facilitator 3 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Facilitator 3 Phone
Facilitator 3 Email
Facilitator 4
Facilitator 4 Name
First Last
Facilitator 4 Relationship
Facilitator 4 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Facilitator 4 Phone
Facilitator 4 Email
Name
This field is for validation purposes and should be left unchanged.

Velocity Technology Solutions, Inc.

1712 Pioneer Avenue, Suite 253, Cheyenne, WY 82001

Velocity Technology Solutions, Inc.

1712 Pioneer Avenue, Suite 253, Cheyenne, WY 82001

Website Design Questionnaire

PPE Intake Worksheet

Buyer Info

Buyer Attorney Information

Buyer Mandate

Facilitator 1

Facilitator 2

Facilitator 3

Facilitator 4