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NEW CUSTOMER SETUP
ENROLLMENT
 
 

 

New Customer Setup Form

Please fill out all information correctly. This information will be used on future mailings and installation requests. If multiple locations, please enter their names, addresses and phone numbers in the Notes Section at the end.


Contacts
Contact 1 Name :
Phone Number :
Cell Number :


Contact 2 Name :
Phone Number :
Cell Number :

Site Information
Company Name :
Address1 :
Address2 :
City :
State :      
Zip Code :
Phone :
Fax :
Email :
Where did you hear about us? :      

Is your billing address the same as your Site address? Place a check mark in the box below and proceed to the Line Information section.

Billing Address
Company Name :
Address1 :
Address2 :
City :
State :      
Zip Code :
Phone :
Fax :
Email :

Line Information
Total # of Lines :
# of Phones :
Current LEC :
Voicemail :

System Information
Current System :      
# of Phones :
Own or Lease : Own       Lease
Do you use VoIP?
Voice over IP : 		Yes        No
Data Provider :

Notes Section
Please include any relevant information, including interest in VoIP technology, Remote Management Systems, Call Center Applications, etc.