Electronic Form Enrollment

1

Name

First Name

Last Name

2

Phone Number

Please enter a valid phone number.

3

Email

example@example.com

4

What type of business do you have?

5

Does your business need a website?

YESNO

6

Does your business need to establish business credit?

YESNO

7

Does your business need funding?

YESNO

8

Would you like assistance setting up your form?

YESNO

9

Please explain what information you would want your form to capture:

10

Do you agree to receive SMS text messaging from IAMDFS Financial Group?* This field is required.

YESNO

11

Terms and Conditions* This field is required.

12

Please Schedule A Time To Discuss Your Form Needs:

13

Once you submit this form you will receive an email to create your account for our electronic form system. If you want assistance setting up your form we will contact you at your scheduled time.