MitechOne | Client Onboarding
Organization Name / DBA
Website Domain
Primary Contact Name
First Name
Last Name
Primary Contact Email
example@example.com
Primary Contact Title
Primary Contact Phone
Please enter a valid phone number.
Primary Contact Phone Extension
Billing Contact Name
First Name
Last Name
Billing Contact Email
example@example.com
Billing Contact Title
Billing Contact Phone
Please enter a valid phone number.
Billing Contact Phone Extension
Corporate Office Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Organization Type
Please Select
Corporation / C
Corporation / Subchapter-S
Partnership
LLC
Sole Proprietorship
Standard Industrial Code (SIC)
For more details or to search for a SIC code for your organization; https://siccode.com/sic-code-lookup-directory
Business Description
Compliances Required
PCI / PCI-DSS (Payment Card Industry Data Security Standard)
HIPAA (Health Insurance Portability and Accountability Act of 1996; improve portability and continuity of Health Insurance and protect patient data / HITECH Act)
SOX (Sarbanes-Oxley Act of 2002; accuracy and reliability of investor data & disclosures)
GLBA (European Union; General Data Protection Regulation)
FERPA (Family Educational Rights and Privacy Act of 1974; student privacy)
CCPA (California Consumer Privacy Act)
Domain Registrar Name
Domain Registrar User ID
Contacts
Name
Title
Phone + Ext
Cell Phone
Email
Contact 1
Contact 2
Contact 3
Contact 4
Submit
Should be Empty: