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New Customer Form

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Please complete this form and click the Submit button at the bottom.  Or you may print the form, fill it by hand and fax it to (480) 626-2136. Also, fax a printer test page for each printer you want to print to from the remote server. You can use the Tab key and mouse to move among fields. There are tips about the kind of information needed for each field in the status bar at the bottom of the screen. If you need any assistance in completing this form, call (480) 607-9030.

Customer billing address:

Company

EIN#

Address1

Address2

City

State

Zip

Main Phone

FAX

Contact1

Phone

e-mail

Contact2

Phone

e-mail

Hosted applications - check all that apply:

CYMAIV versions

QuickBooks Applications

 

FMS

NFP

Client Write-Up

 

QuickBooks No PR DIY DD Assisted

CYMAIV Modules

 

QB Customer Manager

 

GL

AP

AR

Office Applications

 

PR

BR

PO

 

Excel

Word

Access

 

JC

SO

IC

 

Outlook

Power Point

Publisher

F9 Financial Report Writer

HospiceWare

Crystal Reports

Donor Express

 

 

 

 

Other

User information:

User#   User ID   Password  
Name
Address1
Address2
City State Zip
Phone FAX e-mail
Computer Name OS Browser

 

User#   User ID   Password  
Name
Address1
Address2
City State Zip
Phone FAX e-mail
Computer Name OS Browser

 

User#   User ID   Password  
Name
Address1
Address2
City State Zip
Phone FAX e-mail
Computer Name OS Browser

 

User#   User ID   Password  
Name
Address1
Address2
City State Zip
Phone FAX e-mail
Computer Name OS Browser

 

User#   User ID   Password  
Name
Address1
Address2
City State Zip
Phone FAX e-mail
Computer Name OS Browser

 

 
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Last modified: 05/24/06