New Client Setup Form

New Client Setup Form
What is the name of your company?*
What is the company address?*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your name?*

First NameLast Name
What is your email?*
example@example.com
Does your company subscribe (pay) to use Pinata?*

YesNo
What are the primary brand(s)/product(s) you will activate?*
Please list in order of importance
In which states will you execute events with us? Select all that apply*

AlabamaGeorgiaNorth CarolinaSouth CarolnaTennessee
Will you be invoiced directly or through your distributor(s)?*
Please give as complete a breakdown as possible for which distributor will be invoiced in which market and for what brands.*
I.E. Invoice Empire Distributing in Georgia for Brand A and B but invoice RNDC for Brand C
Please list all emails that need to receive a copy of the invoice.*
Should be Empty: