app.smartsheet.com
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Submitted URL: https://app.smartsheet.com/b/form/895301bb0f69458aaa4ab894896b9e62
Effective URL: https://app.smartsheet.com/b/form/895301bb0f69458aaa4ab894896b9e62
Submission: On December 03 via manual from US — Scanned from DE
Effective URL: https://app.smartsheet.com/b/form/895301bb0f69458aaa4ab894896b9e62
Submission: On December 03 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
<form>
<div class="css-mhadp e1tmc1mx0">
<div data-client-id="container_Customer Name" data-client-type="text" id="qypowGX" class="css-12ees97 ef83ajd0"><label for="text_box_Customer Name" data-client-id="label_Customer Name" class="css-1ilwm46 ekxsfat0">Customer Name<span
data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="0" id="text_box_Customer Name" data-client-id="text_box_Customer Name" data-client-type="" name="qypowGX" maxlength="4000" class="css-bhxjq8 e1407lhe0" value=""></div>
</div>
</div>
<div class="css-mhadp e1tmc1mx0">
<div data-client-id="container_Customer Number" data-client-type="text" id="eEl8Z89" class="css-12ees97 ef83ajd0"><label for="text_box_Customer Number" data-client-id="label_Customer Number" class="css-1ilwm46 ekxsfat0">Customer Number<span
data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<p id="description_Customer_Number" class="css-piass0 e5k3c9p0">Enter the customer number found on the request form.</p>
<div style="display: flex;"><input title="" aria-invalid="false" aria-describedby="description_Customer_Number" tabindex="0" id="text_box_Customer Number" data-client-id="text_box_Customer Number" data-client-type="" name="eEl8Z89"
maxlength="4000" class="css-bhxjq8 e1407lhe0" value=""></div>
</div>
</div>
<div class="css-mhadp e1tmc1mx0">
<fieldset data-client-id="container_Action" data-client-type="radio" data-client-align="horizontal" id="E8MEjE0" class="css-15buk42 etth7i50">
<legend data-client-id="label_Action" class="css-1m05zaj etth7i52">Action<span data-client-id="required_indicator" class="css-mfmuai etth7i53">*</span></legend>
<p id="description_Action" class="css-piass0 e5k3c9p0">Choose selection below. Failure to provide accurate documentation may result in taxing future orders</p>
<div class="css-zzp3cj etth7i51">
<div class="css-32wm7w etth7i54"><label class="css-1fg467d etth7i56"><input aria-label="I want this account to be Taxable" aria-describedby="description_Action" tabindex="0" data-client-value="I want this account to be Taxable"
data-client-id="radio_Action" type="radio" title="I want this account to be Taxable" name="E8MEjE0" class="css-10i6ipn etth7i57"><span class="css-1pu7ejh etth7i58">I want this account to be Taxable</span></label></div>
<div class="css-32wm7w etth7i54"><label class="css-1fg467d etth7i56"><input aria-label="I am providing Tax certificate ( not 1099 or w9)" aria-describedby="description_Action" tabindex="0"
data-client-value="I am providing Tax certificate ( not 1099 or w9)" data-client-id="radio_Action" type="radio" title="I am providing Tax certificate ( not 1099 or w9)" name="E8MEjE0" class="css-10i6ipn etth7i57"><span
class="css-1pu7ejh etth7i58">I am providing Tax certificate ( not 1099 or w9)</span></label></div>
<div class="css-32wm7w etth7i54"><label class="css-1fg467d etth7i56"><input aria-label="I would like to be contacted regarding my account" aria-describedby="description_Action" tabindex="0"
data-client-value="I would like to be contacted regarding my account" data-client-id="radio_Action" type="radio" title="I would like to be contacted regarding my account" name="E8MEjE0" class="css-10i6ipn etth7i57"><span
class="css-1pu7ejh etth7i58">I would like to be contacted regarding my account</span></label></div>
</div>
</fieldset>
</div>
<div class="css-mhadp e1tmc1mx0">
<div data-client-id="container_Customer Comments" data-client-type="text" id="n5vW0Qw" class="css-12ees97 ef83ajd0"><label for="textarea_Customer Comments" data-client-id="label_Customer Comments" class="css-1ilwm46 ekxsfat0">Customer
Comments</label><textarea aria-invalid="false" tabindex="0" name="n5vW0Qw" id="textarea_Customer Comments" data-client-id="textarea_Customer Comments" maxlength="4000" rows="3" class="css-1tm0hz7 e1407lhe1"></textarea></div>
</div>
<div class="css-mhadp e1tmc1mx0">
<fieldset tabindex="0" data-client-id="container_State" data-client-type="multicheckbox" class="css-fvfeur e1wjahh75">
<legend class="css-ir9f7 e1wjahh74">
<div class="css-336d07 e1pe2j9k0">
<div><label data-client-id="label_State" class="css-1ilwm46 ekxsfat0">State</label></div>
</div>
</legend>
<div class="css-7mhy4m e1wjahh71">
<div class="css-dwmqx e6odk5h4"><input aria-label="AL" id="MMPoEo6_multi_checkbox_value_0_AL" name="MMPoEo6" tabindex="0" title="AL" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_0_AL" class="css-d5w927 e1wjahh72">AL</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="AK" id="MMPoEo6_multi_checkbox_value_1_AK" name="MMPoEo6" tabindex="0" title="AK" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_1_AK" class="css-d5w927 e1wjahh72">AK</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="AZ" id="MMPoEo6_multi_checkbox_value_2_AZ" name="MMPoEo6" tabindex="0" title="AZ" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_2_AZ" class="css-d5w927 e1wjahh72">AZ</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="AR" id="MMPoEo6_multi_checkbox_value_3_AR" name="MMPoEo6" tabindex="0" title="AR" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_3_AR" class="css-d5w927 e1wjahh72">AR</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="CA" id="MMPoEo6_multi_checkbox_value_4_CA" name="MMPoEo6" tabindex="0" title="CA" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_4_CA" class="css-d5w927 e1wjahh72">CA</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="CO" id="MMPoEo6_multi_checkbox_value_5_CO" name="MMPoEo6" tabindex="0" title="CO" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_5_CO" class="css-d5w927 e1wjahh72">CO</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="CT" id="MMPoEo6_multi_checkbox_value_6_CT" name="MMPoEo6" tabindex="0" title="CT" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_6_CT" class="css-d5w927 e1wjahh72">CT</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="DE" id="MMPoEo6_multi_checkbox_value_7_DE" name="MMPoEo6" tabindex="0" title="DE" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_7_DE" class="css-d5w927 e1wjahh72">DE</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="DC" id="MMPoEo6_multi_checkbox_value_8_DC" name="MMPoEo6" tabindex="0" title="DC" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_8_DC" class="css-d5w927 e1wjahh72">DC</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="FL" id="MMPoEo6_multi_checkbox_value_9_FL" name="MMPoEo6" tabindex="0" title="FL" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_9_FL" class="css-d5w927 e1wjahh72">FL</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="GA" id="MMPoEo6_multi_checkbox_value_10_GA" name="MMPoEo6" tabindex="0" title="GA" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_10_GA" class="css-d5w927 e1wjahh72">GA</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="HI" id="MMPoEo6_multi_checkbox_value_11_HI" name="MMPoEo6" tabindex="0" title="HI" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_11_HI" class="css-d5w927 e1wjahh72">HI</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="ID" id="MMPoEo6_multi_checkbox_value_12_ID" name="MMPoEo6" tabindex="0" title="ID" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_12_ID" class="css-d5w927 e1wjahh72">ID</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="IL" id="MMPoEo6_multi_checkbox_value_13_IL" name="MMPoEo6" tabindex="0" title="IL" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_13_IL" class="css-d5w927 e1wjahh72">IL</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="IN" id="MMPoEo6_multi_checkbox_value_14_IN" name="MMPoEo6" tabindex="0" title="IN" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_14_IN" class="css-d5w927 e1wjahh72">IN</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="IA" id="MMPoEo6_multi_checkbox_value_15_IA" name="MMPoEo6" tabindex="0" title="IA" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_15_IA" class="css-d5w927 e1wjahh72">IA</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="KS" id="MMPoEo6_multi_checkbox_value_16_KS" name="MMPoEo6" tabindex="0" title="KS" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_16_KS" class="css-d5w927 e1wjahh72">KS</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="KY" id="MMPoEo6_multi_checkbox_value_17_KY" name="MMPoEo6" tabindex="0" title="KY" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_17_KY" class="css-d5w927 e1wjahh72">KY</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="LA" id="MMPoEo6_multi_checkbox_value_18_LA" name="MMPoEo6" tabindex="0" title="LA" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_18_LA" class="css-d5w927 e1wjahh72">LA</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="ME" id="MMPoEo6_multi_checkbox_value_19_ME" name="MMPoEo6" tabindex="0" title="ME" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_19_ME" class="css-d5w927 e1wjahh72">ME</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="MD" id="MMPoEo6_multi_checkbox_value_20_MD" name="MMPoEo6" tabindex="0" title="MD" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_20_MD" class="css-d5w927 e1wjahh72">MD</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="MA" id="MMPoEo6_multi_checkbox_value_21_MA" name="MMPoEo6" tabindex="0" title="MA" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_21_MA" class="css-d5w927 e1wjahh72">MA</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="MI" id="MMPoEo6_multi_checkbox_value_22_MI" name="MMPoEo6" tabindex="0" title="MI" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_22_MI" class="css-d5w927 e1wjahh72">MI</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="MN" id="MMPoEo6_multi_checkbox_value_23_MN" name="MMPoEo6" tabindex="0" title="MN" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_23_MN" class="css-d5w927 e1wjahh72">MN</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="MS" id="MMPoEo6_multi_checkbox_value_24_MS" name="MMPoEo6" tabindex="0" title="MS" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_24_MS" class="css-d5w927 e1wjahh72">MS</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="MO" id="MMPoEo6_multi_checkbox_value_25_MO" name="MMPoEo6" tabindex="0" title="MO" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_25_MO" class="css-d5w927 e1wjahh72">MO</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="MT" id="MMPoEo6_multi_checkbox_value_26_MT" name="MMPoEo6" tabindex="0" title="MT" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_26_MT" class="css-d5w927 e1wjahh72">MT</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="NE" id="MMPoEo6_multi_checkbox_value_27_NE" name="MMPoEo6" tabindex="0" title="NE" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_27_NE" class="css-d5w927 e1wjahh72">NE</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="NV" id="MMPoEo6_multi_checkbox_value_28_NV" name="MMPoEo6" tabindex="0" title="NV" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_28_NV" class="css-d5w927 e1wjahh72">NV</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="NH" id="MMPoEo6_multi_checkbox_value_29_NH" name="MMPoEo6" tabindex="0" title="NH" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_29_NH" class="css-d5w927 e1wjahh72">NH</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="NJ" id="MMPoEo6_multi_checkbox_value_30_NJ" name="MMPoEo6" tabindex="0" title="NJ" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_30_NJ" class="css-d5w927 e1wjahh72">NJ</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="NM" id="MMPoEo6_multi_checkbox_value_31_NM" name="MMPoEo6" tabindex="0" title="NM" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_31_NM" class="css-d5w927 e1wjahh72">NM</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="NY" id="MMPoEo6_multi_checkbox_value_32_NY" name="MMPoEo6" tabindex="0" title="NY" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_32_NY" class="css-d5w927 e1wjahh72">NY</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="NC" id="MMPoEo6_multi_checkbox_value_33_NC" name="MMPoEo6" tabindex="0" title="NC" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_33_NC" class="css-d5w927 e1wjahh72">NC</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="ND" id="MMPoEo6_multi_checkbox_value_34_ND" name="MMPoEo6" tabindex="0" title="ND" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_34_ND" class="css-d5w927 e1wjahh72">ND</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="OH" id="MMPoEo6_multi_checkbox_value_35_OH" name="MMPoEo6" tabindex="0" title="OH" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_35_OH" class="css-d5w927 e1wjahh72">OH</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="OK" id="MMPoEo6_multi_checkbox_value_36_OK" name="MMPoEo6" tabindex="0" title="OK" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_36_OK" class="css-d5w927 e1wjahh72">OK</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="OR" id="MMPoEo6_multi_checkbox_value_37_OR" name="MMPoEo6" tabindex="0" title="OR" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_37_OR" class="css-d5w927 e1wjahh72">OR</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="PA" id="MMPoEo6_multi_checkbox_value_38_PA" name="MMPoEo6" tabindex="0" title="PA" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_38_PA" class="css-d5w927 e1wjahh72">PA</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="RI" id="MMPoEo6_multi_checkbox_value_39_RI" name="MMPoEo6" tabindex="0" title="RI" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_39_RI" class="css-d5w927 e1wjahh72">RI</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="SC" id="MMPoEo6_multi_checkbox_value_40_SC" name="MMPoEo6" tabindex="0" title="SC" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_40_SC" class="css-d5w927 e1wjahh72">SC</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="SD" id="MMPoEo6_multi_checkbox_value_41_SD" name="MMPoEo6" tabindex="0" title="SD" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_41_SD" class="css-d5w927 e1wjahh72">SD</label></span></div>
<div class="css-dwmqx e6odk5h4"><input aria-label="TN" id="MMPoEo6_multi_checkbox_value_42_TN" name="MMPoEo6" tabindex="0" title="TN" type="checkbox" class="css-1u83a8q e6odk5h2"><span class="css-wkykdh e6odk5h1"><label
for="MMPoEo6_multi_checkbox_value_42_TN" class="css-d5w927 e1wjahh72">TN</label></span></div>
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