New Client Form – CNY Webs

COMPANY ESSENTIALS

Company Name *

Company Main Phone *

Company Website

Company Address *

Address Line 1

Address Line 2

City

State

Zip Code

Company Owner Name *

First

Last

Company Owner Email *

Company Owner Phone

BILLING ESSENTIALS

These fields will be used during any billing related situations. Please write them as you’d like them seen on statements or invoices.

Billing Company Name is the same as above? *

Yes
No

Billing Company Name: *

Billing Contact Name is the same as above? *

Yes
No

Billing Contact Name *

First

Last

*As seen on payment cards

Billing Address is the same as the Company Address *

Yes
No

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

*As used for online payments

CONTACT ESSENTIALS

The authorized decision maker is authorized on behalf of the company to make decisions when working with CNY Webs that can generate bills that the company may need to pay. CNY Webs will always communicate any financial decisions. Additional contacts will need direct approval from the owner or authorized decision maker before receiving financially related requests.

The Authorized Contact for the company is: *

Is the Company Owner
Not the Company Owner
Not the Company Owner, there are multiple Authorized Contacts

Authorized Decision Maker Name *

First

Last

Authorized Decision Maker Email *

Authorized Decision Maker Phone *

Secondary Authorized Decision Maker Name *

First

Last

Secondary Authorized Decision Maker Email *

Secondary Authorized Decision Maker Phone *

INITIAL SITUATION

Let's get a better understanding of your current situation and what you're dealing with.

Technical Expertise *

This will help us most affectively communicate with you when discussing technical information.

Have you worked with other Web Development or Technology Support companies in the past?

No
Yes, Web Development
Yes, Technology Support
Both

Name of current or previous Web Development company?

Name of current or previous Technology Support company?

Your situation and what your looking to accomplish? *

Provide any details on your current situation and what you're looking to accomplish.

How did you find CNY Webs? *

Person who referred you to CNY Webs: *

First

Last

Description of how you found CNY Webs: