Record

Exclusive field for the State Board of Equalization.

Date

Date on which the application is delivered to CANIETI.

CANIETI Member Number

Exclusive field to be filled in by CANIETI.

Company Name

Corporate name of the company.

Current Address of the Company

Company address.

Complete Name of the Owner

Name of the person acting as the Company’s representative, who will be assigned the Primary Card.

Main line of business of the Industry

Main activity of the Company.

Main products or raw material purchased in California for its processing or resale

Products that the Company wants to purchase in California and which uses to process or resell in its business.

Telephone numbers

Telephone number(s) of the company.

Catalogue codes

Exclusive field to be filled in by CANIETI.

Additional cards

Name(s) of the person(s) authorized to be issued an additional card. In this case the application must be accompanied by an authorization letter in headed paper of the Company.

New

Mark in case it is applied for the first time.

Preapproved

Mark in case of renewal of card previously granted.

Renewed with change

Mark in case you have modified any information corresponding to your company.

Lost card

Mark in case you have lost your card and you are applying for its replacement; it should be noted that lost cards will be reissued once.

Number of previous card

In case you have a card, write the number corresponding to it.

Name

Write the complete name of the person applying for the card.

Delivery date

Exclusive field to be filled in by CANIETI.

Notes

Exclusive field to be filled in by the State Board of Equalization.