Account Setup Form

Your Email

Owner Group

Customer Company Name

Customer U#

Customer LOB

Have you sent the customer the account verification/enrollment form?

PLEASE BE ADVISED It is the account manager/rep's responsibility to add contracts for ANY pricing program and to send new customers their account enrollment form

Weekly ServiceFee Options

Fee Exempt (no fee - must provide reason) / No Invoice Fee (default market $5 fee) / Custom Invoice Fee (must supply pricing proposal)

Additional Accounts Associated?

This includes all like‑named accounts (even if they’re outside your market), plus dead leads, old/non‑migrated accounts, and anything else that may still exist in Salesforce under that business name.

Invoicing Preference

Notes

If there's an AUTH PU# for us to waive, please list here and any other pertinent account information we need to have to complete operational onboarding setup