Customer Information Form

1

What type of customer are you?* This field is required.Feel free to select both!

Business

Residential

2

What type of business do you run?* This field is required.Feel free to select more than one!

Advertising & Media

Arts, Culture & Entertainment

Automotive & Marine

Business & Professional Services

Construction Equipment & Contractors

Events & Event Providers

Family, Community & Civic Organizations

Finance & Insurance

Government & Education

Health Care

Home & Garden

Housing & Property Management

Legal

Lodging & Travel

Manufacturing, Production & Wholesale

Non-Profits

Personal Services & Care

Pets & Veterinary

Public Utilities & Environment Services

Real Estate, Moving & Storage

Recreation & Activities

Restaurants, Food & Beverages

Shopping & Retail

Transportation

Other

3

Business Name* This field is required.What is your business billing name?

4

Business Address* This field is required.What is the physical address?

5

Is your business mailing address the same as your physical address?* This field is required.Does USPS deliver to your physical address?

Yes

No

6

Business Mailing Address* This field is required.What is the billing address?

7

Business PhonePrimary business number used by the public.

If it's the same as your mobile or business number, leave blank.

8

Business WebsitePlease provide the website URL for your business

9

Business Email AddressPrimary business Email address used by the public like Info@BusinessName.com

If it's that same as your direct email address, leave blank.

10

Billing Email AddressBilling Email address that you would like CC'ed on all invoice Emails.

If it's that same as your direct email address, leave blank.

11

Customer Name* This field is required.Preferred First and Last name

12

Job Title* This field is required.Owner, General Manager, Assistant Manager, etc.

13

Office Email Address* This field is required.Direct business Email address

14

Personal Email Address* This field is required.Direct personal Email address

15

Office PhoneDirect business number to your office desk. If it's the same as your mobile number leave blank

16

Mobile Phone* This field is required.Personal or business cell phone number

17

Home PhoneHome landline phone number

18

Local Address* This field is required.Physical local address in Mono or Inyo County

19

Is your personal mailing address the same as your physical address?* This field is required.Does USPS deliver to your physical address?

Yes

No

20

Personal Mailing Address* This field is required.What is the billing address?

21

Date of BirthUsed for discounts/specials

22

Additional Business Contact* This field is required.Do you have any partners/employees who are authorized to request MyMammothTech to do work on behalf of the business?

Yes

No

23

Contact Name* This field is required.Preferred First and Last name

24

Job Title* This field is required.Owner, General Manager, Assistant Manager, etc.

25

Email Address* This field is required.Direct business Email address

26

Office PhoneDirect office phone number

27

Mobile Phone* This field is required.Personal or business cell phone number

28

Additional Business Contact #2* This field is required.Do you have any additional partners/employees who are authorized to request MyMammothTech to do work on behalf of the business?

Yes

No

29

Contact Name* This field is required.Preferred First and Last name

30

Job Title* This field is required.Owner, General Manager, Assistant Manager, etc.

31

Email Address* This field is required.Direct business Email address

32

Office PhoneDirect office phone number

33

Mobile Phone* This field is required.Personal or business cell phone number

34

Additional Business Contact #3* This field is required.Do you have any additional partners/employees who are authorized to request MyMammothTech to do work on behalf of the business?

Yes

No

35

Contact Name* This field is required.Preferred First and Last name

36

Job Title* This field is required.Owner, General Manager, Assistant Manager, etc.

37

Email Address* This field is required.Direct business Email address

38

Office PhoneDirect office phone number

39

Mobile Phone* This field is required.Personal or business cell phone number

40

Additional Personal Contact* This field is required.Do you have any family members who are authorized to request MyMammothTech to do work without your permission?

Yes

No

41

Contact Name* This field is required.Preferred First and Last name

42

Email Address* This field is required.Direct personal Email address

43

Mobile Phone* This field is required.Personal cell phone number

44

Additional Personal Contact #2* This field is required.Do you have another family member who is authorized to request MyMammothTech to do work without your permission?

Yes

No

45

Contact Name* This field is required.Preferred First and Last name

46

Email Address* This field is required.Direct personal Email address

47

Mobile Phone* This field is required.Personal cell phone number

48

Additional Personal Contact #3* This field is required.Do you have another family member who is authorized to request MyMammothTech to do work without your permission?

Yes

No

49

Contact Name* This field is required.Preferred First and Last name

50

Email Address* This field is required.Direct personal Email address

51

Mobile Phone* This field is required.Personal cell phone number

52

Addition Site InformationAll fields are completely optional

Front Door Code

Garage Code

Gate Code

Lock Box Code

ISP (Internet Service Provider)

Modem Ownership

ISP Account Number

ISP Security PIN

54

Customer NotesIf you would like to provide any more information please feel free to do it here.