This is the form used in NC and that we sold for years to customers in all states, in printable form. It has the basic questions and contact info and should be kept on file for each customer. This is in PDF format and prints on a single sheet of paper. Every state is different, so we can't guarantee it will meet the guidelines in your state, but we haven't had a problem with this form in the last 27 years.
When viewing, you can save it to a folder for use later and print them as you need them.
Click here to view a copy